Safety and Efficacy of Cangrelor in Acute Myocardial Infarction-Related Cardiogenic Shock With and Without Cardiac Arrest.

BACKGROUND: Patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) with and without cardiac arrest (CA) may experience delayed onset and absorption of oral P2Y12 inhibitors potentially leading to acute adverse events.

AIMS: To assess the efficacy and safety of Cangrelor in AMI-CS with and without CA, focusing on early stent thrombosis rates, bleeding events, and cardiovascular mortality.

METHODS: A total of 168 patients treated with Cangrelor for AMI-CS (Society for Cardiovascular Angiography & Interventions (SCAI)-SHOCK stage C or higher) with and without CA were retrospectively included. Cangrelor administration protocol included a bolus of 30 μg/kg followed by an infusion of 4 μg/kg/min for 2-4 h.

RESULTS: The mean age was 66.3 ± 11.4 years and 75.6% (127/168) were male. CA occurred in 60.7% (102/168) of patients, with a mean time to return of spontaneous circulation (ROSC) of 21.9 ± 24.3 min. The mean left ventricular ejection fraction (LVEF) was 33.2 ± 13.1%. No cases of acute stent thrombosis or reinfarction (< 48 h) were observed. In-hospital mortality during index hospitalization occurred in 29.7% (49/168) of cases. Patients who presented with CA had a significantly higher mortality (36.3% vs. 13.6%, p = 0.002). Significant bleeding complications (BARC 3-5) were observed in 25.6% (43/168) of patients. The use of mechanical circulatory support (MCS) was significantly associated with more BARC 3-5 bleeding (univariate OR 5.00; 95% CI 2.15 to 13.42; p < 0.001; multivariate p = 0.014). The mean cangrelor infusion dose was not linked to an increased bleeding risk (OR 1.00; 95% CI 1.00 to 1.00; p = 0.229). Preprocedural and discharge use of prasugrel, ticagrelor, or clopidogrel also showed no significant impact on BARC 3-5 bleeding (preprocedural p = 0.115, 0.223 and 0.831; discharge p = 0.455, 0.148 and 0.473, respectively). Following multivariate adjustment, the use of MCS, intensive care unit (ICU) duration, and reduced LVEF were the only predictors of bleeding risk (p = 0.014, 0.010, and 0.042, respectively).

CONCLUSION: Cangrelor effectively prevents acute stent thrombosis and reinfarction within 48 h. Patients with MCS, longer ICU duration and reduced LVEF are at increased risk of bleeding complications. Cangrelor infusion duration per se was not associated with an increased risk of significant bleeding.