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Comparison of myocardial reperfusion between intracoronary versus intravenous cangrelor administration in patients undergoing primary percutaneous coronary intervention
, 1, 2, 1, 1, 3, 3, 2, 3, 1, 3, 2, 1
Affiliations- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
- Structural Intervention Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Medicine, Car eggi University Hospital, Florence, Italy
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Abstract
Background: Myocardial reperfusion is the main target of treatment in patients with ST-segment
elevation myocardial infarction (STEMI). The intracoronary administration of cangrelor bolus could
favor a higher local drug concentration, favoring an earlier thrombotic resolution and a reduced distal
micro-embolization.
Methods: Seventy-one patients undergoing primary percutaneous coronary intervention (PCI) for
STEMI: 37 treated with intracoronary and 34 with intravenous bolus administration of cangrelor. The
primary endpoint was ST-segment elevation resolution (STR) ≥ 50% after 30 min from the end of the
PCI. Other explorative reperfusion indices investigated were: STR ≥ 50% at 24 hours, STR ≥ 70% at
30 min, Thrombolysis In Myocardial Infarction frame count and the QT dispersion. Moreover, acute
and subacute stent thrombosis, bleeding events and 30-day mortality have been evaluated.
Results: More frequent STR ≥ 50% was observed in the intravenous cangrelor bolus group as compared
to the intracoronary administration at 30 min (71.9% vs. 45.5%; p = 0.033), the difference was
maintained 24 hours after PCI (87.1% vs. 63.6%; p = 0.030). STR ≥ 70% at 30 min was statistically
more frequent in the intravenous bolus administration cohort (66.7% vs. 28.6% p = 0.02). At multivariable
analysis, intravenous cangrelor administration was significantly related to STR ≥ 50% (odds
ratio: 3.586; 95% confidence interval: 1.134–11.335; p = 0.030). The incidence of Bleeding Academic
Research Consortium 3–5 bleedings was 15.5% and mortality was 4.2% without any significant difference
between the two groups.
Conclusions: In conclusion the results of the study do not show any advantages in the administration
of intracoronary bolus of cangrelor in patients affected by STEMI and treated with primary PCI.
Abstract
Background: Myocardial reperfusion is the main target of treatment in patients with ST-segment
elevation myocardial infarction (STEMI). The intracoronary administration of cangrelor bolus could
favor a higher local drug concentration, favoring an earlier thrombotic resolution and a reduced distal
micro-embolization.
Methods: Seventy-one patients undergoing primary percutaneous coronary intervention (PCI) for
STEMI: 37 treated with intracoronary and 34 with intravenous bolus administration of cangrelor. The
primary endpoint was ST-segment elevation resolution (STR) ≥ 50% after 30 min from the end of the
PCI. Other explorative reperfusion indices investigated were: STR ≥ 50% at 24 hours, STR ≥ 70% at
30 min, Thrombolysis In Myocardial Infarction frame count and the QT dispersion. Moreover, acute
and subacute stent thrombosis, bleeding events and 30-day mortality have been evaluated.
Results: More frequent STR ≥ 50% was observed in the intravenous cangrelor bolus group as compared
to the intracoronary administration at 30 min (71.9% vs. 45.5%; p = 0.033), the difference was
maintained 24 hours after PCI (87.1% vs. 63.6%; p = 0.030). STR ≥ 70% at 30 min was statistically
more frequent in the intravenous bolus administration cohort (66.7% vs. 28.6% p = 0.02). At multivariable
analysis, intravenous cangrelor administration was significantly related to STR ≥ 50% (odds
ratio: 3.586; 95% confidence interval: 1.134–11.335; p = 0.030). The incidence of Bleeding Academic
Research Consortium 3–5 bleedings was 15.5% and mortality was 4.2% without any significant difference
between the two groups.
Conclusions: In conclusion the results of the study do not show any advantages in the administration
of intracoronary bolus of cangrelor in patients affected by STEMI and treated with primary PCI.
Keywords
primary percutaneous coronary intervention, ST-segment elevation myocardial infarction, cangrelor, intracoronary bolus administration, ST-segment elevation resolution, myocardial reperfusion
About this articleTitle
Comparison of myocardial reperfusion between intracoronary versus intravenous cangrelor administration in patients undergoing primary percutaneous coronary intervention
Journal
Issue
Article type
Original Article
Pages
587-594
Published online
2021-09-23
Page views
1594
Article views/downloads
619
DOI
10.5603/CJ.a2021.0108
Pubmed
Bibliographic record
Cardiol J 2023;30(4):587-594.
Keywords
primary percutaneous coronary intervention
ST-segment elevation myocardial infarction
cangrelor
intracoronary bolus administration
ST-segment elevation resolution
myocardial reperfusion
Authors
Iacopo Muraca
Matteo Pennesi
Alessio Mattesini
Angela Migliorini
Nazario Carrabba
Giacomo Virgili
Filippo Bruscoli
Pierluigi Demola
Riccardo Colombi
Giulia Pontecorboli
Niccolò Marchionni
Carlo Di Mario
Renato Valenti
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