Martino Pepe1, Claudio Larosa2, Plinio Cirillo3, Eugenio Carulli4, Cinzia Forleo4, Palma L Nestola4, Vincenzo Ercolano3, Pasquale D'Alessandro5, Arturo Giordano6, Giuseppe Biondi-Zoccai7,8, Marco Moscarelli9, Angela I Palmiotto2, Giovanni Esposito3, Stefano Favale4. 1. Section of Cardiovascular Diseases, Department of Cardiothoracic (DAI), University of Bari, Bari, Italy - drmartinopepe@gmail.com. 2. Division of Cardiology, Lorenzo Bonomo Hospital, Andria, Barletta-Andria-Trani, Italy. 3. School of Medicine, Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. 4. Section of Cardiovascular Diseases, Department of Cardiothoracic (DAI), University of Bari, Bari, Italy. 5. Department of Cardiology, Santissima Annunziata Hospital, Taranto, Italy. 6. Unit of Invasive Cardiology, "Pineta Grande" Hospital, Castel Volturno, Caserta, Italy. 7. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy. 8. Mediterranea Cardiocentro, Naples, Italy. 9. Department of Cardiothoracic and Vascular, Maria Cecilia Hospital GVM Care and Research, Cotignola, Ravenna, Italy.
Abstract
BACKGROUND: Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and oral P2Y<inf>12</inf> inhibitor (P2Y<inf>12</inf>-I) represents the standard of care for patients with acute coronary syndromes (ACS) or with chronic coronary syndromes (CCS) treated with percutaneous coronary intervention (PCI). Cangrelor, the first intravenous P2Y<inf>12</inf>-I, is deemed to overcome the drawbacks of the oral administration; nevertheless, real world data on this new drug are scanty. We sought to investigate routine clinical use of cangrelor in four interventional centers of Italy. METHODS: We enrolled 241 consecutive patients (196 ACS, 45 CCS) treated with cangrelor during PCI. Drug administration modalities and in-hospital clinical outcomes were evaluated. A subanalysis in patients selected based on the CHAMPION Phoenix trial inclusion/exclusion criteria (CHAMPION-like subpopulation) was also performed. RESULTS: Cangrelor was mainly utilized in ACS patients, who presented poorer clinical conditions and higher bleeding risk. Cangrelor was given only in P2Y<inf>12</inf>-I naïve patients; switch to clopidogrel was always done at the end of the infusion, while ticagrelor or prasugrel were prevalently given 30 minutes before. In-hospital mortality was 10.0% and GUSTO moderate/severe bleeding was 2.5%. Bleeding data showed nevertheless to be in line with the CHAMPION Phoenix results in the "CHAMPION-like" subpopulation. CONCLUSIONS: Cangrelor was predominantly used in ACS with modalities substantially in accord with the label indications. Poor clinical outcomes are due to the prevalent utilization in highly challenging clinical settings, nevertheless the rate of bleeding and stent thrombosis are in line with the randomized trials if analyzed in a subpopulation of comparable risk profile.
BACKGROUND: Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and oral P2Y<inf>12</inf> inhibitor (P2Y<inf>12</inf>-I) represents the standard of care for patients with acute coronary syndromes (ACS) or with chronic coronary syndromes (CCS) treated with percutaneous coronary intervention (PCI). Cangrelor, the first intravenous P2Y<inf>12</inf>-I, is deemed to overcome the drawbacks of the oral administration; nevertheless, real world data on this new drug are scanty. We sought to investigate routine clinical use of cangrelor in four interventional centers of Italy. METHODS: We enrolled 241 consecutive patients (196 ACS, 45 CCS) treated with cangrelor during PCI. Drug administration modalities and in-hospital clinical outcomes were evaluated. A subanalysis in patients selected based on the CHAMPION Phoenix trial inclusion/exclusion criteria (CHAMPION-like subpopulation) was also performed. RESULTS: Cangrelor was mainly utilized in ACS patients, who presented poorer clinical conditions and higher bleeding risk. Cangrelor was given only in P2Y<inf>12</inf>-I naïve patients; switch to clopidogrel was always done at the end of the infusion, while ticagrelor or prasugrel were prevalently given 30 minutes before. In-hospital mortality was 10.0% and GUSTO moderate/severe bleeding was 2.5%. Bleeding data showed nevertheless to be in line with the CHAMPION Phoenix results in the "CHAMPION-like" subpopulation. CONCLUSIONS: Cangrelor was predominantly used in ACS with modalities substantially in accord with the label indications. Poor clinical outcomes are due to the prevalent utilization in highly challenging clinical settings, nevertheless the rate of bleeding and stent thrombosis are in line with the randomized trials if analyzed in a subpopulation of comparable risk profile.
Authors: Leonardo De Luca; Paolo Calabrò; Fabio Chirillo; Cristina Rolfo; Alberto Menozzi; Piera Capranzano; Maurizio Menichelli; Elisa Nicolini; Ciro Mauro; Carlo Trani; Francesco Versaci; Fabrizio Tomai; Giuseppe Musumeci; Carlo Di Mario; Martino Pepe; Sergio Berti; Carlo Cernetti; Plinio Cirillo; Diego Maffeo; Giuseppe Talanas; Marco Ferlini; Marco Contarini; Valerio Lanzilotti; Marino Scherillo; Giuseppe Tarantini; Simone Muraglia; Roberta Rossini; Leonardo Bolognese Journal: Clin Cardiol Date: 2022-06-22 Impact factor: 3.287