Oral P2Y12 inhibitors only versus cangrelor in critically ill patients requiring percutaneous coronary interventions supported by microaxial flow pumps

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Ischemic coronary artery disease requiring Impella-supported percutaneous coronary intervention (n=295). Intervention: Cangrelor loading vs. Oral P2Y12 inhibitor loading only (ticagrelor, prasugrel, or clopidogrel). Primary outcome: Periprocedural major bleeding (BARC ≥ 3) within 48 h (OR 1.00, 95% CI 0.58-1.73, p=1.00).

Q: What does this research mean for the field?

In patients undergoing Impella-supported percutaneous coronary intervention, cangrelor loading results in similar rates of periprocedural major bleeding and 6-month MACE compared with oral P2Y12 inhibitors alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

C. P. Schaffner; Yanick Spahr; Alessandro Spirito; Gregorio Tersalvi; Irena Majcen; Fırat Erdoğan; Yuan Zhi; Armin Spahr; T Seiler; Adrian Attinger; Florim Cuculi; Matthias Bossard

doi:10.1016/j.ijcha.2026.101928

April 28, 2026IJC Heart & VasculatureOpen Access

Oral P2Y12 inhibitors only versus cangrelor in critically ill patients requiring percutaneous coronary interventions supported by microaxial flow pumps

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Why the study?

Cangrelor offers rapid and reversible platelet inhibition, but its role in critically ill patients requiring PCI supported by microaxial flow pumps remains unclear.

Does oral P2Y12 inhibitor loading only, compared to cangrelor loading, reduce bleeding or improve ischemic outcomes in critically ill patients undergoing Impella-supported PCI?

Study Design

Type

Cohort (n=295)

Multicenter

No

Structured PICO

Does oral P2Y12 inhibitor loading only, compared to cangrelor loading, reduce bleeding or improve ischemic outcomes in critically ill patients undergoing Impella-supported PCI?

P

Population

295 adult patients (mean age 67.8 years, 19.3% female) requiring Impella-supported percutaneous coronary intervention for ischemic causes, followed for 6 months.

E

Exposure

Oral P2Y12 inhibitor loading only (ticagrelor, prasugrel, or clopidogrel) administered directly in the catheterization laboratory, followed by maintenance therapy for 6-12 months.

C

Comparator

Intravenous cangrelor loading (30 µg/kg bolus followed by a continuous infusion of 4 µg/kg/min) followed by transition to an oral P2Y12 inhibitor (ticagrelor or clopidogrel).

O

Outcome

Periprocedural major bleeding (Bleeding Academic Research Consortium [BARC] stage ≥ 3) within 48 hours, in-hospital major adverse cardiovascular events (MACE: composite of recurrent MI, CVI, and CV mortality), and 6-month MACE.composite

Main Result

Odds Ratio: 1 (95% CI 0.58–1.73)

Absolute Event Rate: 33% vs 26.4%

p-value: p=1.00

In patients undergoing Impella-supported PCI, relying on oral P2Y12 inhibitor loading alone yields comparable bleeding and ischemic outcomes compared to routine intravenous cangrelor loading.

Limitations

Single-center observational analysis, limiting generalizability and precluding causal inference.
Non-random treatment allocation and potential residual confounding by indication despite inverse probability weighting.
Small sample size and limited number of events, which constrained statistical power and multivariable modeling.
Exploratory and non-prespecified subgroup analyses without adjustment for multiplicity.
Potential temporal confounding due to evolving clinical practices and strategies over the 10-year study period.
Heterogeneity in antiplatelet strategies and variations in cangrelor infusion duration were not fully captured.
Observational design
Potential unmeasured confounding

Implication

Supports oral P2Y12 loading alone in Impella-supported PCI; leaves open whether RCTs would confirm similar bleeding and MACE rates.

Abstract

Background: i cangrelor offers rapid and reversible platelet inhibition, but its role in this setting remains unclear. Objective: i only versus loading with cangrelor. Methods: i. Periprocedural major bleeding (BARC ≥ 3) within 48 h, in-hospital major adverse cardiovascular events (MACE) and 6-month MACE were analyzed. Results: i group (26.4% versus 33.0%, p = 0.2). Early stent thrombosis rates were relatively low and not significantly different (1.0% versus 2.1%, p = 0.6). Presentation with cardiogenic shock was associated with a higher risk for post-PCI major bleeding (OR 7.09, 95%CI 2.97-18.49) and 6-month MACE (HR 2.01, 95% CI 1.01-3.97). Conclusion: i, with consistent results after adjustment. Given the observational design, these findings require confirmation in randomized trials.

Discussion

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Cite This Study

Schaffner et al. (2026) conducted a cohort in Ischemic coronary artery disease requiring Impella-supported percutaneous coronary intervention (n=295). Cangrelor loading vs. Oral P2Y12 inhibitor loading only (ticagrelor, prasugrel, or clopidogrel) was evaluated on Periprocedural major bleeding (BARC ≥ 3) within 48 h (OR 1.00, 95% CI 0.58-1.73, p=1.00).

synapsesocial.com/papers/6a081eea7de338f10b108199 https://doi.org/10.1016/j.ijcha.2026.101928

Topics

Dual antiplatelet therapy

Percutaneous coronary intervention

Chronic total occlusion PCI

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Oral P2Y12 inhibitors only versus cangrelor in critically ill patients requiring percutaneous coronary interventions supported by microaxial flow pumps

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Oral P2Y12 inhibitors only versus cangrelor in critically ill patients requiring percutaneous coronary interventions supported by microaxial flow pumps

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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