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Use of cangrelor in patients with reduced renal function: Post-hoc analysis from the ARCANGELO study
Piera Capranzano1, Paolo Calabrò2, Giuseppe Musumeci3
1Cardiology Division, Policlinico Hospital, University of Catania, Catania, Italy.
Insights
Cangrelor transition to oral P2Y12 inhibitors is safe for acute coronary syndrome patients with reduced renal function. Outcomes for bleeding and ischemic events were similar across renal function groups in this clinical practice study.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Cangrelor use in patients with reduced renal function remains under-investigated.
- Acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) often require P2Y12 inhibitors.
- Assessing safety and efficacy in renal impairment is crucial for ACS management.
Purpose of the Study:
- To evaluate bleeding and ischemic outcomes in ACS patients transitioning from cangrelor to oral P2Y12 inhibitors.
- To compare outcomes in subgroups stratified by renal function (eGFR <60 vs. ≥60 mL/min).
- To assess cangrelor's role in routine clinical practice for patients with varying renal function.
Main Methods:
- Post-hoc analysis of the ARCANGELO study.
- Stratification of patients based on Estimated Glomerular Filtration Rate (eGFR).
- Assessment of Bleeding Academic Research Consortium (BARC) bleedings, Major Adverse Cardiac Events (MACEs), and Intraprocedural Thrombotic Events (IPTEs).
Main Results:
- 17.7% of patients had reduced renal function (eGFR <60 mL/min) and higher comorbidity rates.
- Despite more comorbidities, bleeding, IPTE, and MACE frequencies were similarly low between renal function groups.
- A higher proportion of patients with reduced renal function experienced moderate-severe (BARC type 3-5) bleeding (2.2% vs. 0.2%).
Conclusions:
- Transitioning from cangrelor to oral P2Y12 inhibitors is safe and effective in ACS patients with reduced renal function undergoing PCI.
- Cangrelor can be safely used in routine practice for this patient population.
- While overall outcomes are similar, careful monitoring for moderate-severe bleeding in renal impairment is warranted.
Background:
The use of cangrelor in patients with reduced renal function has never been investigated. This post-hoc analysis of the itAlian pRospective Study on CANGrELOr (ARCANGELO) study aims to assess bleeding and ischemic outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) and transitioning from cangrelor to any oral P2Y12 inhibitors in clinical practice in subgroups stratified by renal function.
Methods:
The patients were stratified according to their Estimated-Glomerular-Filtration-Rate (eGFR) value (<60 [LGFR] vs ≥60 [HGFR] mL/min). Bleeding Academic Research Consortium (BARC)-defined outcomes, Major Adverse Cardiac Events (MACEs), Intraprocedural Thrombotic Events (IPTEs), and other safety parameters were assessed in the two subgroups.
Results:
Of 770 patients included in this post-hoc analysis, 136 (17.7%) had LGFR. These patients had a higher frequency of comorbidities, including diabetes (34.6% vs. 20.0%, p = 0.0004) and atrial fibrillation (10.3% vs. 2.4%, p = 0.0001) than those HGFR. A higher rate of LGFR patients had NSTEMI (54.4% vs. 44.5%) (p = 0.0350) and a multi-vessel coronary artery disease (67.6%) than HGFR ones (48.3%, p < 0.0001). While rates of bleeding, IPTE, and MACEs were similarly low in LGFR and HGFR patients during the 30-day observation period, a higher proportion of LGFR patients (2.2%) experienced BARC type 3-5 (moderate-severe) bleeding compared to HGFR patients (0.2%; p = 0.0188). The type and frequency of MACEs and adverse events in this fragile population were similar to those observed in the overall patients treated with cangrelor.
Conclusions:
These data suggest that the transition from cangrelor to any oral P2Y12 inhibitor is a safe and effective treatment in patients with acute coronary syndrome and reduced renal function undergoing PCI in the setting of routine clinical practice.
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