Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Duke University, Durham, NC.
J Card Fail. 2024 Oct;30(10):1233-1240. doi: 10.1016/j.cardfail.2024.08.003.
Little is known about the use of cangrelor in patients with myocardial infarction (MI) presenting with cardiogenic shock (CS).
CAMEO (Cangrelor in Acute MI: Effectiveness and Outcomes) is a multicenter observational registry evaluating platelet inhibition in patients with MI. We examined the duration of cangrelor infusion and the amount of time to transition from cangrelor to an oral P2Y inhibitor in patients with CS. We also assessed major adverse cardiovascular events (MACEs) and bleeding risks, stratified by dosage duration, time to transition and oral P2Y inhibitor potency.
Among 2352 cangrelor-treated patients with MI, 249 patients were in CS. Among the patients with CS, 16 (6.4%) received the "bridge" infusion dose, 202 (81.1%) the PCI cangrelor infusion dose, and 30 (12.0%) had a combination of both infusion doses. Patients with CS had a median age of 66 years; 32% were women; 21% were Black patients; 35% had diabetes; 19% received thrombectomy; and 59% received mechanical circulatory support (MCS) (35% intra-aortic balloon pump, 27% Impella). The median duration of infusion was 3.9 (2-21.5 hours) in patients with CS and was 2 (1.6-3.1 hours) for all cangrelor-treated patients. The median duration of transition from cangrelor to oral P2Y inhibitor administration was 0.1 (-0.5-21.0 hours) for patients with CS. In multivariable modeling, chronic lung disease and the use of MCS and was associated with longer cangrelor infusions (defined as > 3.9 hours). Among cangrelor-treated patients with CS, 24.1% of these patients had a bleeding event, and 41.8% had a MACE event. After adjustment, a longer cangrelor infusion duration was associated with increased risk of bleeding (P < 0.05).
The median duration of cangrelor infusion was longer for patients presenting with CS. Use of MCS was associated with longer cangrelor infusion durations in patients with CS. Further work is needed to understand the pharmacodynamics of antiplatelet agents in patients with CS.
对于因心源性休克（CS）而出现心肌梗死（MI）的患者，使用坎格雷洛的情况知之甚少。
CAMEO（急性 MI 中的坎格雷洛：有效性和结局）是一项多中心观察性注册研究，评估了 MI 患者的血小板抑制作用。我们检查了 CS 患者的坎格雷洛输注持续时间和从坎格雷洛转为口服 P2Y 抑制剂的时间。我们还评估了主要不良心血管事件（MACE）和出血风险，按剂量持续时间、过渡时间和口服 P2Y 抑制剂效力分层。
在 2352 名接受坎格雷洛治疗的 MI 患者中，有 249 名患者患有 CS。在 CS 患者中，16 名（6.4%）接受了“桥接”输注剂量，202 名（81.1%）接受了 PCI 坎格雷洛输注剂量，30 名（12.0%）接受了这两种输注剂量的联合治疗。CS 患者的中位年龄为 66 岁；32%为女性；21%为黑人患者；35%患有糖尿病；19%接受了血栓切除术；59%接受了机械循环支持（MCS）（35%主动脉内球囊泵，27%Impella）。CS 患者的中位输注持续时间为 3.9 小时（2-21.5 小时），所有接受坎格雷洛治疗的患者的中位输注持续时间为 2 小时（1.6-3.1 小时）。CS 患者从坎格雷洛转为口服 P2Y 抑制剂治疗的中位时间为 0.1 小时（-0.5-21.0 小时）。多变量建模显示，慢性肺部疾病和使用 MCS 与更长的坎格雷洛输注时间相关（定义为>3.9 小时）。在 CS 接受坎格雷洛治疗的患者中，有 24.1%的患者发生出血事件，有 41.8%的患者发生 MACE 事件。调整后，较长的坎格雷洛输注时间与出血风险增加相关（P<0.05）。
CS 患者的坎格雷洛输注中位持续时间较长。CS 患者中，使用 MCS 与坎格雷洛输注时间延长相关。需要进一步研究以了解 CS 患者抗血小板药物的药效学。
