Use of Cangrelor for Patients Undergoing Coronary Artery Bypass Grafting

BACKGROUND: Little is known about the use of cangrelor in patients with acute myocardial infarction (AMI) undergoing coronary artery bypass grafting (CABG). OBJECTIVES: The purpose of this study was to examine characteristics and patterns of cangrelor utilization of CABG patients in CAMEO (Cangrelor in Acute Myocardial Infarction: Effectiveness and Outcomes), a multicenter registry of AMI patients receiving cangrelor and/or oral P2Y12 inhibitors. METHODS: We examined characteristics and patterns of cangrelor utilization in AMI patients who underwent CABG. Patients receiving cangrelor post-CABG were excluded. "Bridge" dosing was defined as cangrelor ≤1 μg/kg/min and percutaneous coronary intervention (PCI) dosing (>1 and ≤ 4 μg/kg/min). RESULTS: In CAMEO, 246 patients underwent CABG (42.3% received cangrelor). Of these, 30.9% received cangrelor only, 11.4% received an oral P2Y12 inhibitor and cangrelor, 8.9% received an oral P2Y12 inhibitor followed by cangrelor, 21.1% received an oral P2Y12 inhibitor only, and 36.6% received neither. The median age was 63 vs 66 years in cangrelor- vs non-cangrelor-treated patients. Patients treated with cangrelor were more likely to have PCI during hospitalization (P < 0.001) and less likely to have radial access (P = 0.005). Time from admission to CABG and overall length of stay was shorter for cangrelor- vs non-cangrelor-treated patients (median 3.8 vs 5.1 days; 10.5 vs 12.7 days). Among cangrelor-treated CABG patients, 26% received the "bridge" dose, 64% received the PCI dose, and 10% received a combination of both. CONCLUSIONS: Cangrelor use in patients with AMI undergoing CABG varies, with over 25% of cangrelor-treated patients receiving "bridge" dosing prior to CABG. Timing from hospital admission to CABG and overall length of stay were significantly shorter in cangrelor-treated patients.