Effects of Cangrelor as Adjunct Therapy to Percutaneous Coronary Intervention
Beyene, Solomon
Brathwaite, Echo
Buchanan, Kyle
Dan, Kazuhiro
Dheendsa, Aaphtaab
Gajanana, Deepakraj
Garcia-Garcia, Hector M
Hideo-Kajita, Alexandre
Iantorno, Micaela
Kolm, Paul
Meirovich, Yael
Melaku, Gebremedhin
Ozaki, Yuichi
Rogers, Toby
Torguson, Rebecca
Waksman, Ron
text
xx
2019
monographic
en
Copyright (c) 2019. Published by Elsevier Inc.
Percutaneous coronary intervention (PCI) in patients with angiographic evidence of intracoronary thrombus is associated with in-hospital and 30-day adverse clinical outcomes. Cangrelor, a direct, rapid-onset acting intravenous P2Y<sub>12</sub> receptor inhibitor, has been proved to be effective by reducing peri-PCI ischemic complications in subjects who underwent PCI. This study aimed to assess the angiographic and in-hospital clinical outcomes in all-comer patients receiving cangrelor immediately before PCI at a tertiary care center. The study analyzed consecutive unselected subjects treated with cangrelor at the time the decision was made to proceed with PCI. At the end of the procedure, all patients were transitioned to oral antiplatelet therapy. The target lesion angiographic assessment of Thrombolysis in myocardial infarction flow grade (TIMI-Flow), TIMI-thrombus grade (TIMI-Thrombus), myocardial blush grade, and TIMI-myocardial perfusion grade (TMPG) was performed before and post-PCI. Clinical events were recorded during the procedure and at discharge. In total, 223 patients (244 lesions) were included in the analysis (106, 97, and 20 patientswith TIMI-Flow 0/1, TIMI-Flow 2/3, and cardiogenic shock, respectively). The overall mean age was 63 +/- 12 years, 70% men and 38% with diabetes mellitus. Acute myocardial infarction was the main presentation (72%). The use of cangrelor improved TIMI-Flow, MGB, TMPG, and TIMI-Thrombus in patients with initial TIMI-Flow 0 to 2. Major bleeding rate was 2.0%. In conclusion, cangrelor was effective and safe in restoring TIMI-Flow 3, reducing thrombus burden and improving myocardial blush grade and TMPG when administered to unselected subjects who underwent PCI. Therefore, cangrelor should be considered in patients presenting with intracoronary thrombus before intervention.
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English
*Adenosine Monophosphate/aa [Analogs & Derivatives]
*Coronary Thrombosis/th [Therapy]
*Percutaneous Coronary Intervention/mt [Methods]
Adenosine Monophosphate/tu [Therapeutic Use]
Aged
Coronary Angiography
Coronary Thrombosis/di [Diagnosis]
Female
Follow-Up Studies
Humans
Male
Middle Aged
Purinergic P2Y Receptor Antagonists/tu [Therapeutic Use]
Retrospective Studies
Treatment Outcome
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
0002-9149
https://dx.doi.org/10.1016/j.amjcard.2019.01.031
https://dx.doi.org/10.1016/j.amjcard.2019.01.031
Ovid MEDLINE(R)
190314