Department of Medical Sciences, Cardiology, Uppsala University, Sjukhusvägen 7, 752 09 Uppsala, Sweden.
Department of Cardiology, Västerås Hospital, Sigtunagatan, 721 89 Västerås, Sweden.
Eur Heart J Cardiovasc Pharmacother. 2019 Jul 1;5(3):151-157. doi: 10.1093/ehjcvp/pvz002.
This nationwide study aimed to analyse the first 2 years of routine clinical use of cangrelor in all Swedish patients undergoing percutaneous coronary intervention (PCI).
This observational Swedish Coronary Angiography and Angioplasty Registry (SCAAR) study identified 915 cangrelor-treated patients. As 899 were ST-segment elevation myocardial infarction (STEMI)-patients undergoing primary PCI, we decided to exclude all non-STEMI patients (n = 16) from the following analysis. We then identified all primary PCI patients, January 2016 to January 2018 (n = 10 816). Excluding hospitals without cangrelor use, tailoring time frames from first cangrelor use per hospital, patients treated with cangrelor (n = 899) were compared with those without cangrelor treatment (n = 4614). A separate analysis was performed for cardiac arrest STEMI patients (n = 273). Cangrelor-use in primary PCI varied greatly between hospitals (4-36%, mean 16%). At variance with randomized trials, cangrelor was used nearly exclusively in STEMI, often with cardiac arrest (19%). Cangrelor was combined with ticagrelor in two-thirds of patients, among which >50% was prehospital. Cangrelor was used more frequently in high-risk patients: left main PCI, thrombus aspiration, and cardiac arrest. Despite cangrelor being used in more high-risk patients, crude definite stent thrombosis rates at 30 days were low and similar in cangrelor (0.7%) and non-cangrelor treated patients (0.8%).
Cangrelor was used nearly exclusively in primary PCI STEMI patients, predominantly with ticagrelor. Despite being used in very high-risk patients, often with cardiac arrest, cangrelor treatment was associated with low stent thrombosis rates.
本项全国性研究旨在分析在所有接受经皮冠状动脉介入治疗（PCI）的瑞典患者中，坎格雷洛常规临床应用的头 2 年情况。
本项观察性瑞典冠状动脉造影和血管成形术登记研究（SCAAR）纳入了 915 例接受坎格雷洛治疗的患者。由于 899 例为 ST 段抬高型心肌梗死（STEMI）患者，行直接 PCI，我们决定将所有非 STEMI 患者（n=16）排除在以下分析之外。然后，我们纳入了 2016 年 1 月至 2018 年 1 月期间所有的直接 PCI 患者（n=10816）。排除未使用坎格雷洛的医院，按照各医院首次使用坎格雷洛的时间定制时间框架，将接受坎格雷洛治疗的患者（n=899）与未接受坎格雷洛治疗的患者（n=4614）进行比较。对心脏骤停 STEMI 患者（n=273）进行了单独分析。各医院直接 PCI 中坎格雷洛的使用率差异很大（4%-36%，平均 16%）。与随机试验不同，坎格雷洛几乎仅用于 STEMI，且常伴有心脏骤停（19%）。三分之二的患者将坎格雷洛与替格瑞洛联合使用，其中 50%以上为院前用药。坎格雷洛更多地用于高危患者：左主干 PCI、血栓抽吸和心脏骤停。尽管在高危患者中使用了更多的坎格雷洛，但 30 天的明确支架血栓形成率较低，且在坎格雷洛（0.7%）和未使用坎格雷洛的患者（0.8%）中相似。
坎格雷洛几乎仅用于直接 PCI 的 STEMI 患者，主要与替格瑞洛联合使用。尽管在极高危患者中使用，且常伴有心脏骤停，但坎格雷洛治疗与较低的支架血栓形成率相关。
