Clinical use of cangrelor: nationwide experience from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Issue 3 (28th January 2019)

• Record Type: Journal Article
• Authors: Grimfjärd, Per; Lagerqvist, Bo; Erlinge, David; Varenhorst, Christoph; James, Stefan
• Is Part Of: European heart journal. Volume 5:Issue 3(2019:Jul.)
• Page Start: 151
• Page End: 157
• Publication Date: 2019-01-28
• Subjects: Cangrelor -- Primary PCI -- STEMI -- Cardiac arrest; Cardiovascular pharmacology -- Periodicals; 615.71
• DOI: 10.1093/ehjcvp/pvz002
• Languages: English
• ISSNs: 2055-6837

Abstract

Abstract: Aims: This nationwide study aimed to analyse the first 2 years of routine clinical use of cangrelor in all Swedish patients undergoing percutaneous coronary intervention (PCI). Methods and results: This observational Swedish Coronary Angiography and Angioplasty Registry (SCAAR) study identified 915 cangrelor-treated patients. As 899 were ST-segment elevation myocardial infarction (STEMI)-patients undergoing primary PCI, we decided to exclude all non-STEMI patients ( n = 16) from the following analysis. We then identified all primary PCI patients, January 2016 to January 2018 ( n = 10 816). Excluding hospitals without cangrelor use, tailoring time frames from first cangrelor use per hospital, patients treated with cangrelor ( n = 899) were compared with those without cangrelor treatment ( n = 4614). A separate analysis was performed for cardiac arrest STEMI patients ( n = 273). Cangrelor-use in primary PCI varied greatly between hospitals (4–36%, mean 16%). At variance with randomized trials, cangrelor was used nearly exclusively in STEMI, often with cardiac arrest (19%). Cangrelor was combined with ticagrelor in two-thirds of patients, among which >50% was prehospital. Cangrelor was used more frequently in high-risk patients: left main PCI, thrombus aspiration, and cardiac arrest. Despite cangrelor being used in more high-risk patients, crude definite stent thrombosis rates at 30 days were low and similar in cangrelor (0.7%) and non-cangrelor treated patients (0.8%). Conclusion: Cangrelor was used nearly exclusively in primary PCI STEMI patients, predominantly with ticagrelor. Despite being used in very high-risk patients, often with cardiac arrest, cangrelor treatment was associated with low stent thrombosis rates.