Key result
Real-world cangrelor use in ACS varies widely, with ~31% receiving oral P2Y12 inhibitors first.
Why the study?
Despite guideline recommendations and clinical trial evidence, real-world data on cangrelor use, transition strategies to oral P2Y12 inhibitors, and associated treatment patterns in ACS remain limited.
Does the timing of oral P2Y12 inhibitor administration relative to cangrelor initiation affect clinical outcomes in ACS patients undergoing PCI?
Observational (n=626)
Yes
Does the timing of oral P2Y12 inhibitor administration relative to cangrelor initiation affect clinical outcomes in ACS patients undergoing PCI?
Real-world use of cangrelor in ACS patients demonstrates significant variability in infusion duration and transition timing to oral P2Y12 inhibitors, with about a third of patients receiving oral P2Y12 inhibitors prior to cangrelor without apparent differences in short-term bleeding or MACE.
No difference in major bleeding by P2Y12 timing; hypothesis-generating and should not yet alter cangrelor transition practices.
Introduction Cangrelor is the only available intravenous P2Y 12 inhibitor and is primarily used in patients with acute coronary syndromes (ACS), especially those presenting with cardiac arrest without prior oral P2Y 12 therapy. Despite guideline recommendations and evidence from the CHAMPION trials, real-world data on its use remain limited. This study evaluated real-world cangrelor use in patients with ACS, with a particular focus on transition strategies from oral P2Y₁₂ inhibitor therapy and associated treatment patterns. Methods We performed a retrospective cross-sectional analysis using data from a nationwide Austrian registry including 10 high-volume percutaneous coronary intervention (PCI) centers over a 7-year period. The timing of concomitant antiplatelet and anticoagulant therapy was assessed. Major adverse cardiovascular events (MACE) and bleeding complications occurring during the index hospitalization, for up to 7 days, were recorded. Results A total of 626 patients were consecutively enrolled over a 7-year period. Cangrelor was administered for a median duration of 2.5 h. Marked inter-center differences were observed in transition strategies and pre-procedural antithrombotic therapy. Overall, 69% of patients received aspirin and heparin alone, whereas 31% also received an oral P2Y 12 inhibitor before cangrelor initiation. Among patients transitioned to a thienopyridine, 9 (6%) received clopidogrel and 6 (4%) received prasugrel before cangrelor discontinuation. Major bleeding (BARC ≥3) occurred in 46 patients (7%), without observed differences according to the timing of oral P2Y 12 inhibitor administration. Conclusion This nationwide real-world study highlights considerable variability in the clinical use of Cangrelor and its integration with oral P2Y 12 inhibitors.
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Beyer et al. (2026) conducted an observational in Acute coronary syndromes (ACS) (n=626). Cangrelor was evaluated on Cangrelor administration patterns and timing of first oral P2Y12 inhibitor administration. In a real-world registry of 626 ACS patients, cangrelor administration showed considerable inter-center variability, with 31% of patients receiving an oral P2Y12 inhibitor before cangrelor initiation.
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