Key result
In routine clinical practice, only 27.3% of MI patients were dosed with cangrelor and transitioned to an oral P2Y12 inhibitor in a manner consistent with pivotal trials and FDA labeling.
Why the study?
Cangrelor reduces ischemic complications without increasing major bleeding in trials, but its use and transition to oral P2Y12 inhibitors in routine practice remained to be examined.
Observational (n=1,355)
Yes
Real-world use of cangrelor in MI patients undergoing PCI shows significant interhospital variability and frequent deviation from FDA-approved dosing and transition protocols.
Variability in cangrelor dosing and transitions to oral P2Y12 inhibitors observed across hospitals; leaves open optimal real-world strategies for MI.
Background In clinical trials, cangrelor has been shown to reduce percutaneous coronary intervention–related ischemic complications without increasing major bleeding. This study was performed to examine cangrelor use and transition to oral P2Y 12 inhibitors in routine clinical practice. Methods and Results The CAMEO (Cangrelor in Acute Myocardial Infarction: Effectiveness and Outcomes) registry is a multicenter, retrospective observational study of platelet inhibition strategies for patients with myocardial infarction undergoing percutaneous coronary intervention. In phase 1, data were collected on consecutive patients with myocardial infarction (n=482) treated with any P2Y 12 inhibitor to understand cangrelor use by hospital. In phase 2, data were collected in a 2:1 (cangrelor‐: non‐cangrelor‐treated) ratio of patients with myocardial infarction (n=873). In phase 1, cangrelor use varied across hospitals (overall, 50.4% [range, 6.0%–100%]). Of patients receiving cangrelor in both phases (n=819), 3.3% received either the bolus or infusion only. Cangrelor was infused for a median of 121 (76–196) minutes; and 38.3% received an infusion for <2 hours. Most patients transitioned from cangrelor to ticagrelor (ticagrelor, 85.3%; clopidogrel, 9.5%; prasugrel, 5.2%). Many patients (16.4%) had a >1‐hour gap between cangrelor cessation and oral P2Y 12 inhibitor initiation; this was highest among those transitioned to clopidogrel (56.6% versus 34.5% prasugrel versus 10.8% ticagrelor; P <0.001). Only 27.3% were dosed with cangrelor and transitioned to an oral P2Y 12 inhibitor in a fashion consistent with the pivotal trials and US Food and Drug Administration label. Conclusions This multicenter registry demonstrated interhospital variability in how cangrelor was administered and transitioned to an oral P2Y 12 inhibitor. These findings highlight opportunities for optimization of cangrelor dosing, infusion duration, and transition of care from the catheterization laboratory to the ward setting.
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Rymer et al. (2022) conducted an observational in Myocardial infarction (n=1,355). Cangrelor vs. Non-cangrelor-treated was evaluated on Proportion of patients dosed and transitioned to an oral P2Y12 inhibitor consistent with FDA label. In routine clinical practice, only 27.3% of MI patients were dosed with cangrelor and transitioned to an oral P2Y12 inhibitor in a manner consistent with pivotal trials and FDA labeling.
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