Clinical practice of cangrelor use in Austrian ACS patients: a real-world multicenter registry

Cangrelor is the only available intravenous P2Y₁₂ inhibitor and is primarily used in patients with acute coronary syndromes (ACS), especially those presenting with cardiac arrest without prior oral P2Y₁₂ therapy. Despite guideline recommendations and evidence from the CHAMPION trials, real-world data on its use remain limited. This study evaluated real-world cangrelor use in patients with ACS, with a particular focus on transition strategies from oral P2Y₁₂ inhibitor therapy and associated treatment patterns.

We performed a retrospective cross-sectional analysis using data from a nationwide Austrian registry including 10 high-volume percutaneous coronary intervention (PCI) centers over a 7-year period. The timing of concomitant antiplatelet and anticoagulant therapy was assessed. Major adverse cardiovascular events (MACE) and bleeding complications occurring during the index hospitalization, for up to 7 days, were recorded.

A total of 626 patients were consecutively enrolled over a 7-year period. Cangrelor was administered for a median duration of 2.5 h. Marked inter-center differences were observed in transition strategies and pre-procedural antithrombotic therapy. Overall, 69% of patients received aspirin and heparin alone, whereas 31% also received an oral P2Y₁₂ inhibitor before cangrelor initiation. Among patients transitioned to a thienopyridine, 9 (6%) received clopidogrel and 6 (4%) received prasugrel before cangrelor discontinuation. Major bleeding (BARC ≥3) occurred in 46 patients (7%), without observed differences according to the timing of oral P2Y₁₂ inhibitor administration.

This nationwide real-world study highlights considerable variability in the clinical use of Cangrelor and its integration with oral P2Y₁₂ inhibitors.