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Bailout Use of Cangrelor During Percutaneous Coronary Intervention and Associated Outcomes
Abhishek Chaturvedi1, Andrew P L Hil1, Patrick Creechan2
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Insights
Cangrelor, an intravenous P2Y12 inhibitor, shows promise as a bailout therapy for thrombotic complications during percutaneous coronary intervention (PCI). This study indicates it safely improves blood flow and resolves thrombus, offering an alternative to other treatments.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Percutaneous coronary intervention (PCI) can be complicated by thrombotic events.
- Limited data exist on the efficacy of cangrelor as a bailout therapy for these complications.
- Cangrelor is an intravenous P2Y12 receptor inhibitor used in PCI.
Purpose of the Study:
- To evaluate the safety and effectiveness of cangrelor when used as bailout therapy during PCI.
- To assess angiographic and clinical outcomes in patients receiving cangrelor for thrombotic complications.
- To determine if cangrelor can serve as an alternative to glycoprotein IIb/IIIa inhibitors.
Main Methods:
- Retrospective screening of patients receiving cangrelor as bailout therapy during PCI from January 2016 to December 2023.
- Analysis of angiographic outcomes including Thrombolysis In Myocardial Infarction (TIMI) flow and thrombus resolution.
- Evaluation of in-hospital clinical outcomes: ischemic events, major bleeding, and length of stay.
Main Results:
- Cangrelor was used as bailout therapy in 67 (2.5%) of 2680 PCI patients.
- Reasons for bailout included slow flow (40.3%), no-reflow (23.9%), stent thrombosis (22.4%), and side branch occlusion (16.4%).
- Significant improvement in TIMI flow (1.3 to 2.7), complete thrombus resolution in 86.7% of stent thrombosis cases, with 11.9% ischemic events and 4.5% major bleeding.
Conclusions:
- Cangrelor is a safe and feasible ad-hoc bailout strategy for thrombotic complications during PCI.
- It effectively improves angiographic flow and resolves thrombus, particularly in cases of stent thrombosis.
- Cangrelor presents a viable alternative to glycoprotein IIb/IIIa inhibitors in specific PCI scenarios.
Abstract:
Cangrelor is an intravenous P2Y12 receptor inhibitor. Data on its use as "bailout" therapy for thrombotic complications during percutaneous coronary intervention (PCI) are lacking. We screened patients who received cangrelor as bailout therapy (if not planned upfront, but used for a clinically indicated reason after the first balloon angioplasty or stent deployment) during PCI at our institution from January 2016 through December 2023. Angiographic (thrombolysis in myocardial infarction (TIMI) flow, resolution of thrombus) and in-hospital clinical outcomes - ischemic events (composite of inpatient mortality, target vessel or lesion revascularization, and ischemic stroke), major bleeding (intracranial hemorrhage, blood transfusion for hemoglobin drop >3 g/dL), and length of stay (LOS) - were analyzed. Of 2680 patients receiving cangrelor during PCI, 67 (2.5%) received it as bailout. The mean age was 66.7 years and 73.1% were male. The reasons for cangrelor bailout included slow flow (40.3%), no-reflow (23.9%), stent thrombosis (22.4%), and acute side branch occlusion (16.4%). Cangrelor significantly improved the mean TIMI flow from 1.3 to 2.7 overall and improved flow in all patients with TIMI-0 flow at the time of bailout. In those with stent thrombosis, cangrelor led to complete (86.7%) or partial (13.3%) resolution of the thrombus on the final angiogram. In-hospital ischemic events occurred in 11.9% and major bleeding in 4.5% of patients. The mean LOS was 5.8 days. Among patients undergoing PCI, the use of cangrelor as an ad-hoc bailout strategy is safe, feasible, and may provide an alternative to glycoprotein IIb/IIIa inhibitors.
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