Cangrelor During Percutaneous Coronary Intervention in Patients With Cardiogenic Shock or Cardiac Arrest.

BACKGROUND

Little is known regarding treatment with cangrelor during percutaneous coronary intervention (PCI) in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest.

OBJECTIVES

The aim of this study was to investigate the effects of such cangrelor treatment during PCI in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest.

METHODS

The study population included patients undergoing PCI (2016-2022) for myocardial infarction with cardiogenic shock or cardiac arrest from SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Propensity score (PS)-matched groups were compared regarding major adverse cardiovascular events (MACE) within 30 days, in-hospital major bleeding, and all-cause mortality within 30 days.

RESULTS

A total of 3,014 patients with cardiogenic shock or cardiac arrest were included, 1,011 receiving and 2,003 not receiving cangrelor. In the PS-matched analysis regarding patients with cardiogenic shock (n = 994), the risk ratio (with vs without cangrelor) was 0.82 (95% CI: 0.71-0.94) for MACE, with an absolute risk reduction of 8.9 percentage points (95% CI: 2.7-15 percentage points) (number needed to treat = 12); 1.60 (95% CI: 0.93-2.76) for major bleeding; and 0.81 (95% CI: 0.70-0.94) for mortality, with an absolute risk reduction of 8.9 percentage points (95% CI: 2.7-15 percentage points) (number needed to treat = 12). In the PS-matched analysis regarding patients with cardiac arrest (n = 1,138), the risk ratio was 1.01 (95% CI: 0.87-1.18) for MACE; 2.26 (95% CI: 1.25-4.11) for major bleeding, with an absolute risk increase of 3.5 percentage points (95% CI: 1.0-5.7 percentage points); and 0.97 (95% CI: 0.83-1.13) for all-cause mortality.

CONCLUSIONS

For patients with cardiogenic shock, administration of cangrelor during PCI was associated with a lower risk for both MACE and all-cause mortality. For patients with cardiac arrest, no such benefit was observed, and a higher risk for major bleeding was found.