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Impact of Cangrelor on Outcomes After Percutaneous Coronary Intervention for Acute Coronary Syndrome in High Bleeding

Abhishek Chaturvedi1, Patrick J Creechan2, Andrew P Hill1

  • 1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.

The American Journal of Cardiology
|March 1, 2026
PubMed

Insights

Cangrelor use in high-bleeding-risk acute coronary syndrome patients undergoing percutaneous coronary intervention did not improve outcomes. Event rates were similar despite higher acuity in the cangrelor group, suggesting potential benefit in select patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • The safety and efficacy of cangrelor in high-bleeding-risk (HBR) acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) require further investigation.
  • Existing data on cangrelor use in this specific patient population are limited, necessitating a focused evaluation.

Purpose of the Study:

  • To evaluate the impact of cangrelor on ischemic and bleeding outcomes in HBR ACS patients following PCI.
  • To compare in-hospital composite ischemic events and major bleeding between cangrelor and non-cangrelor groups in this cohort.

Main Methods:

  • A retrospective analysis of 2509 ACS patients undergoing PCI between 2018-2023 was conducted, with 1007 identified as HBR.
  • Patients requiring specific interventions (cardiogenic shock, thrombectomy, glycoprotein 2b/3a inhibitors) were excluded.
  • Multivariate analysis adjusted for key clinical factors to compare ischemic and major bleeding events between cangrelor and non-cangrelor groups.

Main Results:

  • The study included 1007 HBR ACS patients (mean age 71.8 years, 54.5% male).
  • The cangrelor group presented with higher acuity, including increased rates of ST-elevation ACS, new-onset heart failure, intra-aortic balloon pump use, and acute kidney injury.
  • Multivariate analysis revealed similar rates of ischemic events (OR: 1.52, p=0.30) and major bleeding (OR: 1.65, p=0.09) between the cangrelor and non-cangrelor groups.

Conclusions:

  • Cangrelor use in HBR ACS patients undergoing PCI was not associated with improved ischemic or bleeding outcomes compared to oral P2Y12 inhibitors.
  • Despite higher patient acuity, similar event rates in the cangrelor group suggest a potential benefit in select HBR ACS patients without increasing bleeding risk.

Keywords:
P2Y12 inhibitorsacute coronary syndromecangrelorhigh bleeding riskpercutaneous coronary intervention

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