Key result
Cangrelor during PCI linked to ~18% lower 30-day MACE risk in cardiogenic shock.
Why the study?
Little is known regarding treatment with cangrelor during PCI in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest.
Does cangrelor during PCI reduce 30-day MACE and mortality in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest?
Cohort (n=3,014)
Yes
Does cangrelor during PCI reduce 30-day MACE and mortality in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest?
Relative Risk: 0.82 (95% CI 0.71–0.94)
Absolute Event Rate: 41% vs 50%
Absolute Risk Reduction: 8.9%
Number Needed to Treat: 12
Cangrelor use during PCI in MI complicated by cardiogenic shock is associated with improved 30-day outcomes, but may cause net harm due to increased bleeding without efficacy benefit in cardiac arrest patients.
Cangrelor was associated with lower MACE and mortality in shock but higher bleeding in arrest; leaves open randomized trials before practice change.
BACKGROUND: Little is known regarding treatment with cangrelor during percutaneous coronary intervention (PCI) in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest. OBJECTIVES: The aim of this study was to investigate the effects of such cangrelor treatment during PCI in patients with myocardial infarction complicated by cardiogenic shock or cardiac arrest. METHODS: The study population included patients undergoing PCI (2016-2022) for myocardial infarction with cardiogenic shock or cardiac arrest from SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Propensity score (PS)-matched groups were compared regarding major adverse cardiovascular events (MACE) within 30 days, in-hospital major bleeding, and all-cause mortality within 30 days. RESULTS: A total of 3,014 patients with cardiogenic shock or cardiac arrest were included, 1,011 receiving and 2,003 not receiving cangrelor. In the PS-matched analysis regarding patients with cardiogenic shock (n = 994), the risk ratio (with vs without cangrelor) was 0.82 (95% CI: 0.71-0.94) for MACE, with an absolute risk reduction of 8.9 percentage points (95% CI: 2.7-15 percentage points) (number needed to treat = 12); 1.60 (95% CI: 0.93-2.76) for major bleeding; and 0.81 (95% CI: 0.70-0.94) for mortality, with an absolute risk reduction of 8.9 percentage points (95% CI: 2.7-15 percentage points) (number needed to treat = 12). In the PS-matched analysis regarding patients with cardiac arrest (n = 1,138), the risk ratio was 1.01 (95% CI: 0.87-1.18) for MACE; 2.26 (95% CI: 1.25-4.11) for major bleeding, with an absolute risk increase of 3.5 percentage points (95% CI: 1.0-5.7 percentage points); and 0.97 (95% CI: 0.83-1.13) for all-cause mortality. CONCLUSIONS: For patients with cardiogenic shock, administration of cangrelor during PCI was associated with a lower risk for both MACE and all-cause mortality. For patients with cardiac arrest, no such benefit was observed, and a higher risk for major bleeding was found.
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Emilsson et al. (2025) conducted a cohort in Myocardial infarction complicated by cardiogenic shock or cardiac arrest (n=3,014). Cangrelor vs. No cangrelor was evaluated on Major adverse cardiovascular events (MACE) within 30 days in patients with cardiogenic shock (RR 0.82, 95% CI 0.71-0.94). In patients with myocardial infarction complicated by cardiogenic shock, cangrelor administration during PCI was associated with an 18% lower risk for 30-day MACE (RR 0.82) compared to no cangrelor.
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