Thromb Haemost 2019; 119(07): 1171-1181
DOI: 10.1055/s-0039-1688789
Atherosclerosis and Ischaemic Disease
Georg Thieme Verlag KG Stuttgart · New York

Cangrelor versus Ticagrelor in Patients Treated with Primary Percutaneous Coronary Intervention: Impact on Platelet Activity, Myocardial Microvascular Function and Infarct Size: A Randomized Controlled Trial

Salahaddin Ubaid
1  Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
,
Thomas J. Ford
2  Golden Jubilee National Hospital, Glasgow, United Kingdom
3  British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
,
Colin Berry
2  Golden Jubilee National Hospital, Glasgow, United Kingdom
3  British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
,
Heather M. Murray
4  Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
,
Benjamin Wrigley
1  Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
,
Nazish Khan
1  Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
,
Mark R. Thomas
5  Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
,
Angel L. Armesilla
6  School of Pharmacy, University of Wolverhampton, Wolverhampton, United Kingdom
,
Jon N. Townend
7  Queen Elizabeth Hospital, Birmingham, United Kingdom
,
Saib S. Khogali
1  Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
,
Shahzad Munir
1  Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
,
Joe Martins
1  Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
,
Sandeep S. Hothi
1  Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
,
Elisa J. McAlindon
1  Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
,
James M. Cotton
1  Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
6  School of Pharmacy, University of Wolverhampton, Wolverhampton, United Kingdom
› Author Affiliations
Funding This work was supported by the South Staffordshire Medical Foundation, the Rotha Abraham Bequest and the Royal Wolverhampton Trust (RE/2015005). This study was sponsored by the Royal Wolverhampton NHS Trust. C.B. and T.F. received funding support from the British Heart Foundation (PG/17/2532884; RE/13/5/30177; RE/18/6134217).
Further Information

Publication History

22 January 2019

23 March 2019

Publication Date:
26 May 2019 (eFirst)

Abstract

Background Oral P2Y12 inhibitors take more than 2 hours to achieve full effect in healthy subjects and this action is further delayed in patients with acute myocardial infarction. Intravenous P2Y12 inhibition might lead to more timely and potent anti-platelet effect in the context of emergency primary angioplasty, improving myocardial recovery.

Objectives This article compares the efficacy of intravenous cangrelor versus ticagrelor in a ST-elevation myocardial infarction (STEMI) population treated with primary percutaneous coronary intervention (PPCI).

Materials and Methods In an open-label, prospective, randomized controlled trial, 100 subjects with STEMI were assigned 1:1 to intravenous 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: index of microvascular resistance (IMR), initial infarct size (troponin at 24 hours) and final infarct size at 12 weeks (cardiac magnetic resonance). Secondary endpoints included indices of coronary microcirculatory function (index of microvascular resistance [IMR]), initial infarct size (troponin at 24 hours), final infarct size at 12 weeks (cardiac magnetic resonance), corrected thrombolysis in myocardial infarction (TIMI) frame count, TIMI flow grade, myocardial perfusion grade, and ST-segment resolution (ClinicalTrials.gov NCT02733341).

Results P2Y12 inhibition at first balloon inflation time was significantly greater in cangrelor-treated patients (cangrelor P2Y12 reaction unit [PRU] 145.2 ± 50.6 vs. ticagrelor 248.3 ± 55.1). There was no difference in mean PRU at 4 and 24 to 36 hours post-dosing. IMR, final infarct size, angiographic and electrocardiographic measures of reperfusion were all similar between groups.

Conclusion Cangrelor produces more potent P2Y12 inhibition at the time of first coronary balloon inflation time compared with ticagrelor. Despite this enhanced P2Y12 inhibition, coronary microvascular function and final infarct size did not differ between groups.