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

Abstract

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.