Cangrelor Use in Routine Practice: A Two-Center Experience.

Niels M R Van Der Sangen,Paul Knaapen,Marcel A M Beijk,Ronak Delewi,Yolande Appelman,Niels J W Verouden,M Marije Vis,Alexander Nap,Wouter J Kikkert,Jorrit S Lemkes,José P S Henriques,Bimmer E P M Claessen,Ho Yee Cheung

doi:10.3390/jcm10132829

Abstract

Cangrelor is the first and only intravenous P2Y12-inhibitor and is indicated when (timely) administration of an oral P2Y12 inhibitor is not feasible in patients undergoing percutaneous coronary intervention (PCI). Our study evaluated the first years of cangrelor use in two Dutch tertiary care centers. Cangrelor-treated patients were identified using a data-mining algorithm. The cumulative incidences of all-cause death, myocardial infarction, definite stent thrombosis and major bleeding at 48 h and 30 days were assessed using Kaplan–Meier estimates. Predictors of 30-day mortality were identified using uni- and multivariable Cox regression models. Between March 2015 and April 2021, 146 patients (median age 63.7 years, 75.3% men) were treated with cangrelor. Cangrelor was primarily used in ST-segment elevation myocardial infarction (STEMI) patients (84.2%). Approximately half required cardiopulmonary resuscitation (54.8%) or mechanical ventilation (48.6%). The cumulative incidence of all-cause death was 11.0% and 25.3% at 48 h and 30 days, respectively. Two cases (1.7%) of definite stent thrombosis, both resulting in myocardial infarction, occurred within 30 days, but after 48 h. No other cases of recurrent myocardial infarction transpired within 30 days. Major bleeding occurred in 5.6% and 12.5% of patients within 48 h and 30 days, respectively. Cardiac arrest at presentation was an independent predictor of 30-day mortality (adjusted hazard ratio 5.20, 95%-CI: 2.10–12.9, p < 0.01). Conclusively, cangrelor was used almost exclusively in STEMI patients undergoing PCI. Even though cangrelor was used in high-risk patients, its use was associated with a low rate of stent thrombosis.

Highlights

In 2015 cangrelor became the first intravenous P2Y12 -inhibitor approved for clinical use by the European Medicines Agency (EMA)
In patients with non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina a similar loading dose of aspirin and ticagrelor or prasugrel was combined with 2.5 mg fondaparinux s.c. once daily until percutaneous coronary intervention (PCI)
After adjustment for age and sex in the multivariable model, cardiac arrest remained an independent predictor of 30-day mortality

Summary

Introduction

In 2015 cangrelor became the first intravenous P2Y12 -inhibitor approved for clinical use by the European Medicines Agency (EMA). P2Y12 -inhibitor prior to PCI and when oral P2Y12 -inhibition is not feasible [1,2]. Randomized clinical trials [4,5,6] Pooled data of these trials (n = 24,910) showed that the use of cangrelor was associated with a reduction in peri-procedural ischemic complications (i.e., all-cause death, myocardial infarction, ischemia-driven revascularization or stent thrombosis within 48 h) and an increase in minor (but not major) bleeding events as compared to clopidogrel [7]. Ever since cangrelor gained market authorization, there has been limited data on its use and outcomes in cangrelor-treated patients in routine practice. The objective of this study was to describe (i) patient and procedural characteristics, (ii) clinical outcomes and (iii) the transition to oral P2Y12 -inhibitors of cangrelor-treated patients undergoing coronary angiography or PCI in two Dutch tertiary

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