坎格雷洛在接受经皮冠状动脉介入治疗的急性或慢性冠状动脉综合征患者中的药效学效应：庞贝城登记研究
Pharmacodynamic effects of cangrelor in patients with acute or chronic coronary syndrome undergoing percutaneous coronary intervention: the POMPEII Registry.
作者信息
Gargiulo Giuseppe, Cirillo Plinio, Sperandeo Luca, Castiello Domenico Simone, Manzi Lina, Forzano Imma, Florimonte Domenico, Simonetti Fiorenzo, Canonico Mario Enrico, Avvedimento Marisa, Paolillo Roberta, Spinelli Alessandra, Buongiorno Federica, Serafino Luigi Di, Spaccarotella Carmen Anna Maria, Franzone Anna, Piccolo Raffaele, Stabile Eugenio, Valgimigli Marco, Esposito Giovanni
机构信息
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Cardiovascular Department, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy.
出版信息
EuroIntervention. 2025 May 16;21(10):560-570. doi: 10.4244/EIJ-D-24-00757.
BACKGROUND
Cangrelor is approved for oral P2Y inhibitor-naïve patients undergoing percutaneous coronary intervention (PCI). Pharmacodynamic (PD) investigations in various clinical settings, with various assays, have shown contrasting data in terms of the extent of platelet inhibition and rates of high residual platelet reactivity (HRPR).
AIMS
We aimed to assess the PD effects of cangrelor in all patients receiving it during PCI.
METHODS
PharmacOdynaMic Effects of Cangrelor in PatiEnts wIth Acute or chronIc Coronary Syndrome Undergoing Percutaneous Coronary Intervention (POMPEII Registry; ClinicalTrials.gov: NCT04790032) is an investigator-initiated, prospective study assessing PD effects at 4 timepoints with 3 assays. Clinical outcomes at 30 days were also assessed.
RESULTS
From March 2021 to June 2024, 150 patients undergoing PCI and receiving cangrelor were enrolled (64 patients underwent elective PCI; 30 had non-ST-elevation acute coronary syndrome; and 56 had ST-segment elevation myocardial infarction [STEMI], of whom 24 were pretreated with ticagrelor). Most patients switched from cangrelor to either clopidogrel or ticagrelor. Inhibition of platelet aggregation was moderate during cangrelor infusion (light transmittance aggregometry with adenosine diphosphate 20 μM: 57.6±16.5%), with rates of 3.2% for HRPR and 1.3% for bailout tirofiban. Rates of HRPR were relevant at 3 h (37.9%) and 4-6 h (15.3%), and HRPR occurred significantly more frequently in patients switching to clopidogrel compared with ticagrelor. Rates of ischaemic and bleeding events were low.
CONCLUSIONS
Cangrelor provided effective platelet inhibition in most patients with ACS or CCS undergoing PCI, including those with STEMI who were pretreated with ticagrelor. Switching from cangrelor to an oral P2Y inhibitor, mainly clopidogrel, exposed a large number of patients to a variable period of on-treatment HRPR.
背景
坎格雷洛已被批准用于接受经皮冠状动脉介入治疗（PCI）且未使用过口服P2Y抑制剂的患者。在各种临床环境中使用各种检测方法进行的药效学（PD）研究，在血小板抑制程度和高残余血小板反应性（HRPR）发生率方面显示出相互矛盾的数据。
目的
我们旨在评估坎格雷洛在接受PCI治疗的所有患者中的PD效应。
方法
坎格雷洛在接受经皮冠状动脉介入治疗的急性或慢性冠状动脉综合征患者中的药效学效应（POMPEII注册研究；ClinicalTrials.gov：NCT04790032）是一项由研究者发起的前瞻性研究，通过3种检测方法在4个时间点评估PD效应。还评估了30天时的临床结局。
结果
从2021年3月至2024年6月，纳入了150例接受PCI并使用坎格雷洛的患者（64例接受择期PCI；30例患有非ST段抬高急性冠状动脉综合征；56例患有ST段抬高型心肌梗死[STEMI]，其中24例预先使用替格瑞洛治疗）。大多数患者从坎格雷洛转换为氯吡格雷或替格瑞洛。在输注坎格雷洛期间，血小板聚集抑制程度中等（使用20μM二磷酸腺苷的透光率聚集测定法：57.6±16.5%），HRPR发生率为3.2%，使用替罗非班进行补救的发生率为1.3%。HRPR发生率在3小时（37.9%）和4 - 6小时（15.3%）时较高，与转换为替格瑞洛的患者相比，转换为氯吡格雷的患者中HRPR发生频率显著更高。缺血和出血事件发生率较低。
结论
坎格雷洛在大多数接受PCI的急性冠状动脉综合征（ACS）或慢性冠状动脉综合征（CCS）患者中提供了有效的血小板抑制，包括那些预先使用替格瑞洛治疗的STEMI患者。从坎格雷洛转换为口服P2Y抑制剂，主要是氯吡格雷，使大量患者在治疗期间暴露于不同时间段的HRPR中。
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