Safety of intravenous cangrelor infusion during percutaneous coronary intervention in a real-world cohort of non-pretreated NSTEACS patients
Authors: Arbas Redondo E , Jurado Roman A , Jimenez Valero S , Galeote Garcia G , Moreno Gomez R , Severo Sanchez A , Juarez Olmos V M , Poveda Pinedo I D , Tebar Marquez D , Garcia Escobar A , Vera Vera S , Rey Blas J R , Garcia Garcia A , Gonzalez Davia R , Lopez De Sa E 
Published: October 2022

Abstract

Background and purpose
Since publication of latest ESC guidelines in 2020, pretreatment with an oral P2Y12 receptor inhibitor (P2Y12i) is no longer systematically recommended in patients with non-ST elevation acute coronary syndrome (NSTEACS) [1]. Therefore, from now on, NSTEACS patients will arrive to the cathlab to a larger extent without having a loading dose of an oral P2Y12i administered. Cangrelor, a potent intravenous P2Y12i, is an emerging option that provides a rapid onset of platelet inhibition, but it has not been widely used yet [2]. We aimed to evaluate safety of cangrelor real-world use in NSTEACS patients who had not received an oral P2Y12i before percutaneous coronary intervention (PCI).

Methods
Development of periprocedural thrombotic complications, ischaemic and bleeding events at 30 days was retrospectively evaluated in a cohort of non-pretreated NSTEACS patients referred to PCI. Comparison among those who underwent intravenous infusion of cangrelor and those who received a loading dose of an oral P2Y12i (ticagrelor, prasugrel or clopidogrel) at the moment of PCI was performed.

Results
Between January and December of 2020, 155 non-pretreated NSTEACS patients were referred to our cathlab; of whom, 89 underwent PCI and were included in the analysis (18.0% with unstable angina, 82.0% with NSTEMI). Mean age was 66.0±14.3 years, 21 (23.6%) were female and the mean GRACE risk score was 112±34. PCI was performed ad-hoc (immediately after diagnostic catheterization) in 81 patients (91.0%), whereas 15 patients (16.9%) required PCI to be done in more than two times. Procedure was performed exclusively by radial or cubital artery access in 78 patients (87.6%). Regarding antiplatelet drug administration, cangrelor was used in 14 patients (15.7%), prasugrel in 35 (39.3%), ticagrelor in 29 (32.6%) and clopidogrel in 11 (12.4%). No significant differences were found among patients in terms of development of ischaemic events at 30 days (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or stent thrombosis) or periprocedural thrombotic events (no-reflow, bailout use of anti-IIb/IIIb or intraprocedural stent thrombosis). The use of cangrelor did not raise the incidence of bleeding events at 30 days (7.1% vs. 15.1%, p=0.682) [Table 1]. Cangrelor tended to be more frequently used in high-risk NSTEMI patients (20.8% vs. 12.9%, p=0.357) and in case of complex PCI (26.3% vs. 7.8%, p=0.018) [Figure 1]. After controlling by both variables, cangrelor did not significantly increase the risk of bleeding or ischaemic events at 30 days either.

Conclusions
Intravenous infusion of cangrelor during PCI in non-pretreated NSTEACS patients shows no differences in terms of thrombotic or bleeding events in comparison to the administration of a loading dose of an oral P2Y12i. Our results also suggest that cangrelor could be a safe option in patients with high thrombus burden who require complex PCI.

Funding Acknowledgement
Type of funding sources: None.