P107 EARLY TRANSITION FROM CANGRELOR TO ORAL P2Y12I IS NOT ASSOCIATED WITH INCREASE OF ADVERSE EVENTS

Abstract

Abstract Intro Cangrelor, an intravenous P2Y12 receptor inhibitor (P2Y12i), characterized by rapid onset and offset of antiplatelet action, is approved by guidelines for patients P2Y12i naïve undergoing percutaneous coronary intervention (PCI). Cangrelor infusion duration and time of transition to oral P2Y12i are still debated, although there is a general indication to an infusion of at least 2 hours. The aim of our study is to evaluate the efficacy and the safety of an early transition to oral P2Y12i strategy. Methods Our prospective observational monocentric study enrolled consecutive patients who received Cangrelor during PCI (bolus + infusion iv starting at time of PCI). Clopidogrel and Prasugrel were administered immediately upon discontinuation of Cangrelor infusion, while Ticagrelor was started up to 30 min before Cangrelor was discontinued. Transition was defined as early when Cangrelor infusion duration was less than 2 hours. Endpoints of interest were major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction (MI), stroke and target vessel revascularization (TLR) and stent thrombosis (ST). Safety endpoints were bleeding events divided as major events (BARC 3–5) and minor events (BARC 1–2). Results 133 patients were enrolled: mean age was 69,3±11 years, men were 97 (73%), diabetics 24 (18%). 112 (84%) presented with acute coronary syndrome (tab1). 90% of interventions were done by radial approach, 19% of patients received Clopidogrel as oral P2Y12i. In–hospital MACE were 3, in absence of fatal events; 2 cases of MI (type 4a). The only case of ST was observed with OCT performed during staged PCI of non culprit lesion, with patient totally asymptomatic, without troponin increase and on Clopidogrel as oral P2Y12i. There were 2 BARC 3 events. Patients who received early transition strategy did not presented significant differences of ischemic/bleeding events (tab2). Conclusions Cangrelor demonstrated efficacy and safety in patients undergoing PCI. An early transition strategy to oral P2Y12i was not associated with an increase in both efficacy and safety adverse events in this early phase of our study.