Comparative effectiveness of Cangrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: an observational investigation from the M.O.Ca. registry

• Published in: Scientific reports Vol. 13; no. 1; p. 10685
• Main Authors: Pepe, Martino, Carulli, Eugenio, Larosa, Claudio, Napoli, Gianluigi, Nestola, Palma Luisa, Carella, Maria Cristina, Giordano, Salvatore, Tritto, Rocco, Bartolomucci, Francesco, Cirillo, Plinio, Zoccai, Giuseppe Biondi, Giordano, Arturo, Ciccone, Marco Matteo
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-07-2023; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308; 692/4019; Acute Coronary Syndrome - surgery; Acute coronary syndromes; Angioplasty; Bleeding; Clopidogrel; Hemorrhage; Humanities and Social Sciences; Humans; Implants; Ischemia; multidisciplinary; Patients; Percutaneous Coronary Intervention; Population studies; Registries; Retrospective Studies; Science; Science (multidisciplinary); Thromboembolism; Thrombosis
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-023-37084-2

Cangrelor, the first intravenous P2Y
12
inhibitor (P2Y
12
-I), has been approved on the basis of three large RCTs from the CHAMPION program which nevertheless have been criticized for the low bleeding risk of the enrolled patients, the large quote of chronic coronary syndromes, and the use of Clopidogrel as control arm even in the setting of acute coronary syndromes (ACS). We sought to investigate, in the setting of ACS, the comparative performance of Cangrelor in terms of in-hospital ischemic and haemorrhagic outcomes compared with the current gold-standard of oral P2Y
12
-I. The study retrospectively enrolled 686 consecutive patients admitted to the Divisions of Cardiology of Policlinico of Bari and L. Bonomo Hospital of Andria for ACS and treated with percutaneous coronary intervention. The study population was divided according to the P2Y
12
-I treatment strategy in two groups: patients given an oral P2Y
12
-I and patients receiving Cangrelor in the cath lab followed by an oral P2Y
12
-I. Clinical endpoints included death, ischemic and bleeding events occurring during hospital stay. Cangrelor treated patients presented higher clinical risk profile at presentation and faced higher death rate. However, after PS matching, in-hospital mortality resulted comparable between the groups and Cangrelor use was associated with reduced in-hospital definite stent thrombosis (
p
 = 0.03). Data from our real-world registry highlight that, in the setting of ACS, Cangrelor is prevalently used in patients with very challenging clinical presentations. The adjusted analysis provides for the first time promising data on stent thrombosis reduction associated with Cangrelor use.