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. 2023 Aug 28;3(4):oead076.
doi: 10.1093/ehjopen/oead076. eCollection 2023 Jul.

Safety of cangrelor and transition to oral P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: the ARCANGELO study

Leonardo De Luca  1 , Paolo Calabrò  2 , Piera Capranzano  3 , Carlo Di Mario  4 , Fabio Chirillo  5 , Cristina Rolfo  6 , Alberto Menozzi  7 , Maurizio Menichelli  8 , Leonardo Bolognese  9 , Giuseppe Musumeci  10
Affiliations

Safety of cangrelor and transition to oral P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: the ARCANGELO study

Leonardo De Luca et al. Eur Heart J Open. .

Abstract

Aims: Cangrelor is the only intravenous P2Y12 inhibitor available. Safety, efficacy, and transitioning from cangrelor to oral P2Y12 inhibitors were recorded in patients with acute coronary syndrome (ACS). The ARCANGELO study aims to assess the safety of cangrelor on bleeding and the effects of the transition to oral P2Y12 inhibitors in a real-world setting according to the European Medical Agency's requirement.

Methods and results: Adult patients with ACS undergoing percutaneous coronary intervention (PCI) receiving cangrelor were included in the study. Patients were followed for 30 days. Incidence of bleeding events, major adverse cardiac events, and transition strategy to oral P2Y12 were recorded. Among 1004 ACS patients undergoing PCI, 995 (99.1%) were eligible for the analysis; 597 (60.0%) of them had ST-segment elevation myocardial infarction. A total of 925 (93.1%) patients underwent PCI by radial catheter access, and 972 (97.2%) received drug-eluting stents. All eligible patients received bolus and cangrelor infusion between 2 and 4 h in 95% of the cases. A total of 730 patients (73.4%) received ticagrelor, 127 (12.8%) prasugrel, and 138 (13.9%) clopidogrel as transition therapy. Bleeding, according to Bleeding Academic Research Consortium (BARC) criteria, within 30 days post-PCI occurred in 5.2% of patients (95% confidence interval: 3.9-6.8%); 0.5% experienced a moderate (BARC 3), and all others mild (BARC 1-2) bleeding events. Major adverse cardiac events occurred in 14 (1.4%) patients, principally all-cause mortality (n = 6 patients) and myocardial infarction (n = 7 patients).

Conclusion: The use of cangrelor in ACS patients undergoing PCI and the transition strategy to P2Y12 inhibitors are confirmed as safe and effective in daily practice.

Keywords: Acute coronary syndrome; Bleeding; Cangrelor; P2Y12 receptor inhibitor; Percutaneous coronary intervention.

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Conflict of interest statement

Conflict of interest: All the activities were funded by Chiesi Farmaceutici S.p.A. (Parma, Italy).

Figures

Graphical Abstract
Graphical Abstract
ACS, acute coronary syndrome; BARC, bleeding academic research consortium; GUSTO, global use of strategies to open occluded coronary arteries; NSTE-ACS, non-ST-elevation acute coronary syndromes; PCI, percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction.
Figure 1
Figure 1
Patient disposition of the ARCANGELO study. NSTE-ACS, non–ST-segment elevation acute coronary syndromes; STEMI, ST-segment elevation myocardial infarction.
Figure 2
Figure 2
Transition from cangrelor to oral platelet P2Y12 inhibitor. NSTE-ACS, non–ST-elevation acute coronary syndromes; STEMI, ST-segment elevation myocardial infarction.
Figure 3
Figure 3
Incidence of bleeding events (% of patients) at 48 h (A) and 30 days (B) by Bleeding Academic Research Consortium and Global Use of Strategies to Open Occluded Coronary Arteries classifications. BARC, Bleeding Academic Research Consortium; GUSTO, Global Use of Strategies to Open Occluded Coronary Arteries; NSTE-ACS, non–ST-elevation acute coronary syndromes; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; N, number of patients.
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