Use of Cangrelor in a Contemporary Practice of STEMI Interventions

[Editor's note: This article has a correction from the print version to the disclosure section at the end of the article.]

Abstract

Objectives: To evaluate the safety and efficacy of using cangrelor in a real-world, contemporary practice of ST-segment elevation myocardial infarction (STEMI) interventions with short door-to-balloon (D2B) times. Background: Short D2B times reduce mortality in STEMI interventions. There is a disparity between the race to treat STEMI and the delayed action of oral P2Y12 inhibitors. As a result, in the majority of patients that are P2Y12 inhibitor-naïve, oral agents leave a freshly implanted stent vulnerable to thrombosis. Cangrelor, a parenteral, ultrashort-acting, direct, and reversible-binding P2Y12 inhibitor, has ideal pharmacokinetic attributes for STEMI. Although studied in clinical trials, the use of cangrelor in short D2B time interventions has not been reported. Methods: We conducted a prospective, single-center registry of 50 consecutive short D2B time percutaneous coronary interventions (PCI). Cangrelor was added to the intraprocedural regimen, which included bivalirudin. In-hospital major adverse cardiac events (MACE), stent thrombosis, and bleeding events were monitored. Results: The cohort was predominantly composed of male patients (68%) with a mean age of 64.6 years and a D2B time of 57 minutes. Procedure success was 100% for treating the culprit lesion. There was no stent thrombosis and bleeding rates were low. Four patients expired, two from non-cardiac causes and two due to cardiogenic shock. Conclusions: Use of cangrelor in a contemporary practice of STEMI interventions provides a template for contemporary STEMI management that balances the dual goals of achieving short D2B times and platelet inhibition during and immediately after PCI.