Cangrelor in cardiogenic shock and after cardiopulmonary resuscitation: A global, multicenter, matched pair analysis with oral P2Y 12 inhibition from the IABP-SHOCK II trial

Michal Droppa; Muthiah Vaduganathan; Ramkumar V. Venkateswaran; Abhayjit Singh; Paul M. Szumita; Russel J. Roberts; Arman Qamar; Luis Hack; Dominik Rath; Meinrad Gawaz; Georg Fuernau; Suzanne de Waha-Thiele; Steffen Desch; Steffen Schneider; Taoufik Ouarrak; Farouc A. Jaffer; Uwe Zeymer; Holger Thiele; Deepak L. Bhatt; Tobias Geisler

doi:10.1016/j.resuscitation.2019.02.008

Cangrelor in cardiogenic shock and after cardiopulmonary resuscitation: A global, multicenter, matched pair analysis with oral P2Y 12 inhibition from the IABP-SHOCK II trial

Michal Droppa, Muthiah Vaduganathan, Ramkumar V. Venkateswaran, Abhayjit Singh, Paul M. Szumita, Russel J. Roberts, Arman Qamar, Luis Hack, Dominik Rath, Meinrad Gawaz, Georg Fuernau, Suzanne de Waha-Thiele, Steffen Desch, Steffen Schneider, Taoufik Ouarrak, Farouc A. Jaffer, Uwe Zeymer, Holger Thiele, Deepak L. Bhatt, Tobias Geisler^*

^*Corresponding author for this work

Clinic of Internal Medicine II - Cardiology

51 Citations (Scopus)

Abstract

Aims: Cangrelor has a potentially favorable pharmacodynamic profile in cardiogenic shock (CS). We aimed to evaluate the clinical course of CS patients undergoing percutaneous coronary intervention (PCI) treated with cangrelor. Methods and results: We retrospectively identified 136 CS patients treated with cangrelor. Patients were 1:1 matched to CS patients from the IABP-SHOCK II trial not receiving cangrelor by age, sex, cardiac arrest, type of myocardial infarction, culprit lesion, glycoprotein IIb/IIIa inhibitor, and oral P2Y ₁₂ -receptor inhibitor and followed-up for 12 months. The study cohort consisted of 88 matched pairs. Thirty-day and 12-month mortality was 29.5% and 34.1% in cangrelor-treated patients and 36.4% and 47.1% in control group (P = 0.34 and P = 0.08, respectively). The rate of definite acute stent thrombosis was 2.3% in both groups. Moderate and severe bleeding events occurred in 21.6% in the cangrelor and 19.3% in the control group (P = 0.71). Patients treated with cangrelor more frequently experienced ≥1 TIMI flow grade improvement during PCI (92.9% vs. 81.2%, P = 0.02). Conclusion: Cangrelor treatment was associated with similar bleeding risk and significantly better TIMI flow improvement compared with oral P2Y ₁₂ inhibitors in CS patients undergoing PCI. The use of cangrelor in CS offers a potentially safe and effective antiplatelet option and should be evaluated in randomized trials.

Original language	English
Journal	Resuscitation
Volume	137
Pages (from-to)	205-212
Number of pages	8
ISSN	0300-9572
DOIs	https://doi.org/10.1016/j.resuscitation.2019.02.008
Publication status	Published - 01.04.2019

Funding

MD received travel honoraria by Medtronic. TG reports personal fees from Astra Zeneca, grants and personal fees from Bayer Healthcare, personal fees from Boehringer Ingelheim, grants and personal fees from Bristol Myers Squibb, personal fees from Pfizer, grants and personal fees from Daiichi Sankyo, grants and personal fees from Eli Lilly, grants and personal fees from Medicines Company, personal fees from MSD, grants from Siemens Healthcare, grants from Spartan Bioscience, outside the submitted work MV is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (NIH/NCATS Award UL 1TR002541), serves on advisory boards for Amgen, AstraZeneca, Bayer AG, and Baxter Healthcare, and participates in clinical endpoints committees for studies supported by Novartis and the NIH. AQ is supported by the NHLBI T32 postdoctoral training grant (T32HL007604). FAJ has sponsored research grants from Siemens, and Canon, has a consulting agreement with Boston Scientific, Abbott Vascular and Siemens. Massachusetts General Hospital has a patent licensing arrangement with Canon Corporation, and Dr. Jaffer has the right to receive licensing royalties. UZ discloses the following relationships - Speaker’s honoraria and consulting fees from Bayer, Bristol-Myers Squibb/Pfizer, Daiichi-Sankyo, Boehringer Ingelheim, Trommsdorf, Ferrer. DLB discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (COMPASS clinical trial steering committee funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi (including for his role as co-Chair of the CHAMPION PHOENIX trial), Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company (including for his role as co-Chair of the CHAMPION trials); Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This study was in part funded by the DFG (German Research Foundation) – Project 374031971 – TRR 240.

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)

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10.1016/j.resuscitation.2019.02.008

Cite this

Droppa, M., Vaduganathan, M., Venkateswaran, R. V., Singh, A., Szumita, P. M., Roberts, R. J., Qamar, A., Hack, L., Rath, D., Gawaz, M., Fuernau, G., de Waha-Thiele, S., Desch, S., Schneider, S., Ouarrak, T., Jaffer, F. A., Zeymer, U., Thiele, H., Bhatt, D. L., & Geisler, T. (2019). Cangrelor in cardiogenic shock and after cardiopulmonary resuscitation: A global, multicenter, matched pair analysis with oral P2Y 12 inhibition from the IABP-SHOCK II trial. Resuscitation, 137, 205-212. https://doi.org/10.1016/j.resuscitation.2019.02.008

@article{470a40ba5a534f49a4405f53e49da33d,

title = "Cangrelor in cardiogenic shock and after cardiopulmonary resuscitation: A global, multicenter, matched pair analysis with oral P2Y 12 inhibition from the IABP-SHOCK II trial",

abstract = " Aims: Cangrelor has a potentially favorable pharmacodynamic profile in cardiogenic shock (CS). We aimed to evaluate the clinical course of CS patients undergoing percutaneous coronary intervention (PCI) treated with cangrelor. Methods and results: We retrospectively identified 136 CS patients treated with cangrelor. Patients were 1:1 matched to CS patients from the IABP-SHOCK II trial not receiving cangrelor by age, sex, cardiac arrest, type of myocardial infarction, culprit lesion, glycoprotein IIb/IIIa inhibitor, and oral P2Y 12 -receptor inhibitor and followed-up for 12 months. The study cohort consisted of 88 matched pairs. Thirty-day and 12-month mortality was 29.5\% and 34.1\% in cangrelor-treated patients and 36.4\% and 47.1\% in control group (P = 0.34 and P = 0.08, respectively). The rate of definite acute stent thrombosis was 2.3\% in both groups. Moderate and severe bleeding events occurred in 21.6\% in the cangrelor and 19.3\% in the control group (P = 0.71). Patients treated with cangrelor more frequently experienced ≥1 TIMI flow grade improvement during PCI (92.9\% vs. 81.2\%, P = 0.02). Conclusion: Cangrelor treatment was associated with similar bleeding risk and significantly better TIMI flow improvement compared with oral P2Y 12 inhibitors in CS patients undergoing PCI. The use of cangrelor in CS offers a potentially safe and effective antiplatelet option and should be evaluated in randomized trials. ",

author = "Michal Droppa and Muthiah Vaduganathan and Venkateswaran, \{Ramkumar V.\} and Abhayjit Singh and Szumita, \{Paul M.\} and Roberts, \{Russel J.\} and Arman Qamar and Luis Hack and Dominik Rath and Meinrad Gawaz and Georg Fuernau and \{de Waha-Thiele\}, Suzanne and Steffen Desch and Steffen Schneider and Taoufik Ouarrak and Jaffer, \{Farouc A.\} and Uwe Zeymer and Holger Thiele and Bhatt, \{Deepak L.\} and Tobias Geisler",

year = "2019",

month = apr,

day = "1",

doi = "10.1016/j.resuscitation.2019.02.008",

language = "English",

volume = "137",

pages = "205--212",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

Droppa, M, Vaduganathan, M, Venkateswaran, RV, Singh, A, Szumita, PM, Roberts, RJ, Qamar, A, Hack, L, Rath, D, Gawaz, M, Fuernau, G , de Waha-Thiele, S, Desch, S, Schneider, S, Ouarrak, T, Jaffer, FA, Zeymer, U, Thiele, H, Bhatt, DL & Geisler, T 2019, 'Cangrelor in cardiogenic shock and after cardiopulmonary resuscitation: A global, multicenter, matched pair analysis with oral P2Y 12 inhibition from the IABP-SHOCK II trial', Resuscitation, vol. 137, pp. 205-212. https://doi.org/10.1016/j.resuscitation.2019.02.008

Cangrelor in cardiogenic shock and after cardiopulmonary resuscitation: A global, multicenter, matched pair analysis with oral P2Y 12 inhibition from the IABP-SHOCK II trial. / Droppa, Michal; Vaduganathan, Muthiah; Venkateswaran, Ramkumar V. et al.
In: Resuscitation, Vol. 137, 01.04.2019, p. 205-212.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - Cangrelor in cardiogenic shock and after cardiopulmonary resuscitation: A global, multicenter, matched pair analysis with oral P2Y 12 inhibition from the IABP-SHOCK II trial

AU - Droppa, Michal

AU - Vaduganathan, Muthiah

AU - Venkateswaran, Ramkumar V.

AU - Singh, Abhayjit

AU - Szumita, Paul M.

AU - Roberts, Russel J.

AU - Qamar, Arman

AU - Hack, Luis

AU - Rath, Dominik

AU - Gawaz, Meinrad

AU - Fuernau, Georg

AU - de Waha-Thiele, Suzanne

AU - Desch, Steffen

AU - Schneider, Steffen

AU - Ouarrak, Taoufik

AU - Jaffer, Farouc A.

AU - Zeymer, Uwe

AU - Thiele, Holger

AU - Bhatt, Deepak L.

AU - Geisler, Tobias

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Aims: Cangrelor has a potentially favorable pharmacodynamic profile in cardiogenic shock (CS). We aimed to evaluate the clinical course of CS patients undergoing percutaneous coronary intervention (PCI) treated with cangrelor. Methods and results: We retrospectively identified 136 CS patients treated with cangrelor. Patients were 1:1 matched to CS patients from the IABP-SHOCK II trial not receiving cangrelor by age, sex, cardiac arrest, type of myocardial infarction, culprit lesion, glycoprotein IIb/IIIa inhibitor, and oral P2Y 12 -receptor inhibitor and followed-up for 12 months. The study cohort consisted of 88 matched pairs. Thirty-day and 12-month mortality was 29.5% and 34.1% in cangrelor-treated patients and 36.4% and 47.1% in control group (P = 0.34 and P = 0.08, respectively). The rate of definite acute stent thrombosis was 2.3% in both groups. Moderate and severe bleeding events occurred in 21.6% in the cangrelor and 19.3% in the control group (P = 0.71). Patients treated with cangrelor more frequently experienced ≥1 TIMI flow grade improvement during PCI (92.9% vs. 81.2%, P = 0.02). Conclusion: Cangrelor treatment was associated with similar bleeding risk and significantly better TIMI flow improvement compared with oral P2Y 12 inhibitors in CS patients undergoing PCI. The use of cangrelor in CS offers a potentially safe and effective antiplatelet option and should be evaluated in randomized trials.

AB - Aims: Cangrelor has a potentially favorable pharmacodynamic profile in cardiogenic shock (CS). We aimed to evaluate the clinical course of CS patients undergoing percutaneous coronary intervention (PCI) treated with cangrelor. Methods and results: We retrospectively identified 136 CS patients treated with cangrelor. Patients were 1:1 matched to CS patients from the IABP-SHOCK II trial not receiving cangrelor by age, sex, cardiac arrest, type of myocardial infarction, culprit lesion, glycoprotein IIb/IIIa inhibitor, and oral P2Y 12 -receptor inhibitor and followed-up for 12 months. The study cohort consisted of 88 matched pairs. Thirty-day and 12-month mortality was 29.5% and 34.1% in cangrelor-treated patients and 36.4% and 47.1% in control group (P = 0.34 and P = 0.08, respectively). The rate of definite acute stent thrombosis was 2.3% in both groups. Moderate and severe bleeding events occurred in 21.6% in the cangrelor and 19.3% in the control group (P = 0.71). Patients treated with cangrelor more frequently experienced ≥1 TIMI flow grade improvement during PCI (92.9% vs. 81.2%, P = 0.02). Conclusion: Cangrelor treatment was associated with similar bleeding risk and significantly better TIMI flow improvement compared with oral P2Y 12 inhibitors in CS patients undergoing PCI. The use of cangrelor in CS offers a potentially safe and effective antiplatelet option and should be evaluated in randomized trials.

UR - https://www.scopus.com/pages/publications/85062630976

U2 - 10.1016/j.resuscitation.2019.02.008

DO - 10.1016/j.resuscitation.2019.02.008

M3 - Journal articles

C2 - 30790690

AN - SCOPUS:85062630976

SN - 0300-9572

VL - 137

SP - 205

EP - 212

JO - Resuscitation

JF - Resuscitation

ER -

Cangrelor in cardiogenic shock and after cardiopulmonary resuscitation: A global, multicenter, matched pair analysis with oral P2Y 12 inhibition from the IABP-SHOCK II trial

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