The Use of Cangrelor in Cardiogenic Shock: Insights from the CAMEO Registry.

Autor: Rymer J; Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address: jennifer.rymer@duke.edu., Pichan C; Duke University, Durham, NC., Page C; Duke Clinical Research Institute, Durham, NC., Alhanti B; Duke Clinical Research Institute, Durham, NC., Bhatt DL; Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY., Kochar A; Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY., Angiolillo DJ; University of Florida, Jacksonville, FL., Diaz M; Palmetto General Hospital, Hialeah, FL., Wimmer NJ; ChristianaCare, Newark, DE., Waksman R; Washington MedStar, Washington, D.C., Ang L; University of California San Diego, San Diego, CA., Bach R; Washington University in St. Louis, St. Louis, MO., Jenkins R; Kootenai Health, Coeur d'Alene, ID., El-Sabae H; Chiesi, Cary, NC., Brothers L; Duke Clinical Research Institute, Durham, NC., Ohman EM; Duke Clinical Research Institute, Durham, NC., Jones WS; Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC., Washam JB; Duke Clinical Research Institute, Durham, NC., Wang TY; Duke Clinical Research Institute, Durham, NC., Narcisse D; Duke University, Durham, NC., Basir MB; Henry Ford Health, Detroit, MI.
Jazyk: angličtina
Zdroj: Journal of cardiac failure [J Card Fail] 2024 Oct; Vol. 30 (10), pp. 1233-1240.
DOI: 10.1016/j.cardfail.2024.08.003
Abstrakt: Introduction: Little is known about the use of cangrelor in patients with myocardial infarction (MI) presenting with cardiogenic shock (CS).
Methods: CAMEO (Cangrelor in Acute MI: Effectiveness and Outcomes) is a multicenter observational registry evaluating platelet inhibition in patients with MI. We examined the duration of cangrelor infusion and the amount of time to transition from cangrelor to an oral P2Y 12 inhibitor in patients with CS. We also assessed major adverse cardiovascular events (MACEs) and bleeding risks, stratified by dosage duration, time to transition and oral P2Y 12 inhibitor potency.
Results: Among 2352 cangrelor-treated patients with MI, 249 patients were in CS. Among the patients with CS, 16 (6.4%) received the "bridge" infusion dose, 202 (81.1%) the PCI cangrelor infusion dose, and 30 (12.0%) had a combination of both infusion doses. Patients with CS had a median age of 66 years; 32% were women; 21% were Black patients; 35% had diabetes; 19% received thrombectomy; and 59% received mechanical circulatory support (MCS) (35% intra-aortic balloon pump, 27% Impella). The median duration of infusion was 3.9 (2-21.5 hours) in patients with CS and was 2 (1.6-3.1 hours) for all cangrelor-treated patients. The median duration of transition from cangrelor to oral P2Y 12 inhibitor administration was 0.1 (-0.5-21.0 hours) for patients with CS. In multivariable modeling, chronic lung disease and the use of MCS and was associated with longer cangrelor infusions (defined as > 3.9 hours). Among cangrelor-treated patients with CS, 24.1% of these patients had a bleeding event, and 41.8% had a MACE event. After adjustment, a longer cangrelor infusion duration was associated with increased risk of bleeding (P < 0.05).
Conclusions: The median duration of cangrelor infusion was longer for patients presenting with CS. Use of MCS was associated with longer cangrelor infusion durations in patients with CS. Further work is needed to understand the pharmacodynamics of antiplatelet agents in patients with CS.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE