Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Germany.
Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA.
Resuscitation. 2019 Apr;137:205-212. doi: 10.1016/j.resuscitation.2019.02.008. Epub 2019 Feb 18.
Cangrelor has a potentially favorable pharmacodynamic profile in cardiogenic shock (CS). We aimed to evaluate the clinical course of CS patients undergoing percutaneous coronary intervention (PCI) treated with cangrelor.
We retrospectively identified 136 CS patients treated with cangrelor. Patients were 1:1 matched to CS patients from the IABP-SHOCK II trial not receiving cangrelor by age, sex, cardiac arrest, type of myocardial infarction, culprit lesion, glycoprotein IIb/IIIa inhibitor, and oral P2Y-receptor inhibitor and followed-up for 12 months. The study cohort consisted of 88 matched pairs. Thirty-day and 12-month mortality was 29.5% and 34.1% in cangrelor-treated patients and 36.4% and 47.1% in control group (P = 0.34 and P = 0.08, respectively). The rate of definite acute stent thrombosis was 2.3% in both groups. Moderate and severe bleeding events occurred in 21.6% in the cangrelor and 19.3% in the control group (P = 0.71). Patients treated with cangrelor more frequently experienced ≥1 TIMI flow grade improvement during PCI (92.9% vs. 81.2%, P = 0.02).
Cangrelor treatment was associated with similar bleeding risk and significantly better TIMI flow improvement compared with oral P2Y inhibitors in CS patients undergoing PCI. The use of cangrelor in CS offers a potentially safe and effective antiplatelet option and should be evaluated in randomized trials.
坎格雷洛在心源休克（CS）中具有潜在有利的药效学特征。我们旨在评估接受坎格雷洛治疗的行经皮冠状动脉介入治疗（PCI）的 CS 患者的临床过程。
我们回顾性地确定了 136 例接受坎格雷洛治疗的 CS 患者。通过年龄、性别、心脏骤停、心肌梗死类型、罪犯病变、糖蛋白 IIb/IIIa 抑制剂和口服 P2Y 受体抑制剂，将患者与 IABP-SHOCK II 试验中未接受坎格雷洛治疗的 CS 患者 1:1 匹配，并进行了 12 个月的随访。研究队列包括 88 对匹配的患者。坎格雷洛治疗组的 30 天和 12 个月死亡率分别为 29.5%和 34.1%，对照组分别为 36.4%和 47.1%（P=0.34 和 P=0.08）。两组明确的急性支架血栓形成发生率均为 2.3%。坎格雷洛组和对照组分别有 21.6%和 19.3%发生中度和重度出血事件（P=0.71）。在 PCI 期间，接受坎格雷洛治疗的患者更频繁地经历了≥1 次 TIMI 血流分级改善（92.9% vs. 81.2%，P=0.02）。
与口服 P2Y 抑制剂相比，CS 患者接受坎格雷洛治疗与相似的出血风险相关，并显著改善 TIMI 血流。CS 中使用坎格雷洛提供了一种潜在安全有效的抗血小板选择，应在随机试验中进行评估。
