Abstract 4363332: Comparative Efficacy of Cangrelor in Patients Undergoing PCI in the setting of Cardiogenic Shock or Cardiac Arrest: Insights from Blue Cross and Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry

Background: Cangrelor has more rapid platelet inhibition compared to oral anti-platelet agents. The favorable pharmocokinetics and pharmacodynamics of cangrelor could be advantageous in high-risk acute myocardial infarction (AMI) complicated by cardiac arrest or cardiogenic shock, conditions often associated with altered oral bioavailability of anti-platelet agents. Hypothesis: We investigated the clinical outcomes associated with cangrelor use during percutaneous coronary intervention (PCI) for AMI complicated by cardiac arrest or cardiogenic shock. Methods: All patients undergoing PCI for AMI complicated by shock or cardiac arrest and enrolled in BMC2, a multicenter clinical registry of all PCI procedures at non-federal hospitals in the state of Michigan between 4/2018-12/2024 were included. Patients treated with a Gp IIb/IIIa inhibitor were excluded. The in-hospital outcomes of mortality, major and minor bleeding, and transfusion were evaluated in a propensity-matched analysis using 4:1 greedy match with a caliper of 0.25 standard deviations of the propensity score. Results: A total of 1,850 patients were included in the propensity-matched cohort (mean age 65 years, 67.5% male, 64.5% STEMI). 370 patients received cangrelor compared with 1,480 not receiving cangrelor. 62.2% of patients had cardiogenic shock, 64.6% had cardiac arrest, and 26.8% had both cardiogenic shock and cardiac arrest. In patients undergoing PCI for AMI with either cardiogenic shock or cardiac arrest, the administration of cangrelor was associated with increased major bleeding (13.5% vs 9.0%; p=0.024) and transfusion administration (26.2% vs 17.8%; p <0.001). There was no difference in in-hospital mortality (30.0% vs. 30.3%; p=0.950) or minor bleeding (8.2% vs. 7.1%; p=0.527). Conclusion: Cangrelor administration during PCI for AMI complicated by cardiogenic shock or cardiac arrest was not associated with a difference in in-hospital mortality but was associated with increased major bleeding and transfusions.