Cangrelor in patients with percutaneous coronary intervention for acute myocardial infarction after cardiac arrest and/or with cardiogenic shock

• Verfasst von: Zeymer, Uwe [VerfasserIn]
• Verfasst von: Lober, Christiane [VerfasserIn]
• Verfasst von: Richter, Stephan [VerfasserIn]
• Verfasst von: Olivier, Christoph B [VerfasserIn]
• Verfasst von: Huber, Kurt [VerfasserIn]
• Verfasst von: Haring, Bernhard [VerfasserIn]
• Verfasst von: Schwimmbeck, Peter [VerfasserIn]
• Verfasst von: Andrassy, Martin [VerfasserIn]
• Verfasst von: Akın, Ibrahim [VerfasserIn]
• Verfasst von: Cuneo, Alessandro [VerfasserIn]
• Verfasst von: Desch, Steffen [VerfasserIn]
• Verfasst von: Thiele, Holger [VerfasserIn]
• Verfasst von: Geisler, Tobias [VerfasserIn]
• Titel: Cangrelor in patients with percutaneous coronary intervention for acute myocardial infarction after cardiac arrest and/or with cardiogenic shock
• Verf.angabe: Uwe Zeymer, Christiane Lober, Stephan Richter, Christoph B Olivier, Kurt Huber, Bernhard Haring, Peter Schwimmbeck, Martin Andrassy, Ibrahim Akin, Alessandro Cuneo, Steffen Desch, Holger Thiele, and Tobias Geisler
• E-Jahr: 2023
• Jahr: July 2023
• Illustrationen: Illustrationen
• Fussnoten: Online veröffentlicht: 12. April 2023 ; Gesehen am 13.05.2024
• Titel Quelle: Enthalten in: European heart journal - acute cardiovascular care
• Ort Quelle: Oxford : Oxford University Press, 2012
• Jahr Quelle: 2023
• Band/Heft Quelle: 12(2023), 7 vom: Juli, Seite 462-463
• ISSN Quelle: 2048-8734
• DOI: doi:10.1093/ehjacc/zuad041
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1888373083

Abstract

The highest mortality in patients undergoing percutaneous coronary intervention (PCI) is observed in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS), cardiac arrest (CA) or with the need for mechanical ventilation. It has been shown that the onset of action of oral P2Y12 inhibitors is delayed in patients with CS or after CA, especially in those with therapeutic hypothermia and administration of morphine, which is associated with a high incidence of stent thrombosis.1 Cangrelor is administered intravenously and binds directly at the P2Y12 receptor and thus inhibits Adenodiphosphat (ADP)-induced platelet aggregation within minutes in a complete and rapidly reversible fashion.2 We have performed a retrospective study to assess the use of cangrelor in high-risk patients with acute myocardial infarction (AMI) in a real-world population in Austria and Germany. The methods are given in the Supplementary material. All patients underwent PCI for AMI and presented with heart failure with the need for ventilation (n = 10, 3.3%), CA before PCI (n = 148, 48.8%), CS (n = 42, 13.9%), or CA and CS (n = 103, 34.0%). Baseline characteristics and results of the total population and the four subgroups are given in Table 1. Oral P2Y12 inhibitors used were clopidogrel in 27.8%, prasugrel in 38.0%, and ticagrelor in 36.0%, respectively. The cangrelor infusion was started before PCI in 12.9% of cases and administered for a mean duration of 121.2 ± 53.5 min. The majority of patients (67.4%) was treated for <2 h, 25.3% for 2-4 h, and 7.3% for >4 h. The primary outcome of stent thrombosis and myocardial re-infarction within the first 48 h was reported in two (0.7%) patients. Bleeding Academic Research Consortium (BARC) 2-3 bleeding complications were observed in 11.2% of patients and fatal bleedings (BARC 5) in 3.3%. Total in-hospital mortality was 41.6%, and cardiac mortality was 21.8%. In the matched comparison analysis of 118 patients in each group, comparable Thrombolysis in myocardial infarction (TIMI) 3 patency rates of the infarct-related artery (IRA) after PCI (91.5% vs. 87.9%) and numerically fewer ischaemic events were observed compared with the patients in the CULPRIT-SHOCK trial3 (Figure 1). To the best of our knowledge, this is one of the largest studies evaluating the use of cangrelor in very high-risk patients with AMI undergoing PCI. The results can be summarized as follows: cangrelor is associated with a low rate of stent thrombosis and re-infarction within the first 48 h after PCI; the number of ischaemic and bleeding events and total and cardiac mortality were numerically lower compared with those in a matched patient group of patients with CS from the CULPRIT-SHOCK trial.