Cangrelor vs. Ticagrelor in patients with st segment elevation myocardial infarction treated with primary percutaneous coronary intervention: impact on platelet activity, myocardial micro-vascular function and infarct size

Ubaid, Salahaddin (2020). Cangrelor vs. Ticagrelor in patients with st segment elevation myocardial infarction treated with primary percutaneous coronary intervention: impact on platelet activity, myocardial micro-vascular function and infarct size. University of Birmingham. M.D.

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Abstract

Background The action of oral P2Y12 inhibitors is delayed in patients with acute myocardial infarction. Intravenous P2Y12 inhibition might lead to a more timely and potent antiplatelet effect in the context of primary angioplasty, improving myocardial recovery. Objectives To compare the efficacy of IV cangrelor vs. ticagrelor in a STEMI population treated with primary percutaneous coronary intervention (PCI). Methods In an open-label, prospective, randomized controlled trial, 100 subjects with STEMI were assigned to IV cangrelor or oral ticagrelor. The co-primary endpoints were platelet P2Y12 inhibition at infarct vessel balloon inflation time, 4 and 24 hours. Secondary endpoints included indices of coronary microcirculatory function, myocardial infarct size, and angiographic, and electrocardiographic analysis. (ClinicalTrials.gov NCT02733341). Results P2Y12 inhibition at balloon inflation time was significantly greater in cangrelor-treated patients (cangrelor PRU 145.2 ± 50.6 vs. ticagrelor 248.3 ± 55.1; p<0.001). There was no difference in mean PRU at 4 hours and 24-36 hours post dosing. IMR, final infarct size, angiographic and electrocardiographic measures of reperfusion were all similar between groups. Conclusion Cangrelor produced more potent P2Y12 inhibition at the time of coronary reperfusion compared with ticagrelor. Despite this enhanced antiplatelet effect, coronary microvascular function and infarct size did not differ between groups.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):