Cangrelor in Patients Undergoing Percutaneous Coronary Intervention After Out-of-Hospital Cardiac Arrest

Abstract

Background: Cangrelor provides rapid platelet inhibition, making it a potential option for out-of-hospital cardiac arrest (OHCA) survivors undergoing percutaneous coronary intervention (PCI). However, clinical data on its use after OHCA are limited. This study investigates in-hospital outcomes of cangrelor use in this population. Methods: We conducted a prospective, observational study involving OHCA patients from the Lombardia CARe Registry (January 2015-December 2022) who underwent PCI in seven centers in Northern Italy. Propensity score (PS) matching compared patients who received cangrelor to those who did not. Logistic regression tested associations between cangrelor and discharge outcomes. Results: Of 612 OHCA patients admitted, 414 (67.4%) underwent PCI with known antithrombotic therapy, of whom 34 (8.2%) received cangrelor. Radial access was more common in the cangrelor group, which also had a higher troponin peak and a final TIMI flow grade of 3. Survival at discharge was 82.4% in the cangrelor group, compared to 65.3% in the no-cangrelor group (p = 0.043). Univariable logistic regression showed that cangrelor use was associated with higher survival at discharge (OR 2.5; 95% CI: 1.1-6.1, p = 0.049). After multiple PS matchings, cangrelor remained associated with better survival (OR 2.07; 95% CI: 1.16-2.98). Major bleeding rates were higher in the cangrelor group, even after adjusting for baseline bleeding risk (OR: 7.0; 95% CI: 2.9-17.0; p < 0.001). Conclusions: In OHCA patients undergoing PCI, cangrelor use was linked to improved in-hospital survival but higher major bleeding, suggesting a potential net clinical benefit.

Keywords: cangrelor; coronary artery disease; invasive coronary angiography; out-of-hospital cardiac arrest; percutaneous coronary intervention; platelet aggregation inhibitors.

Figure 1

Study flow-chart. OHCA: out-of-hospital cardiac arrest; ICA: invasive coronary angiography.

Figure 2

Forest plot displaying the effect of cangrelor administration on in-hospital survival derived from 25 propensity-score-matched samples. Black circles represent the odds ratio (OR), and horizontal lines represent the 95% confidence interval (CI) of each one of the 25 matched samples. The overall effect is displayed at the bottom (black diamond). The convergence of the median chi-squared test displayed in Supplementary Figure S1 confirms the robustness of the matching methodology. The bold numbers indicate the significant pairs.