Hemodynamics, fluids & transfusion
Cangrelor versus crushed ticagrelor in acute myocardial infarction complicated by cardiogenic shock (DAPT-SHOCK-AMI): a randomised, double-blind trial
Primary result · Primary clinical endpoint: death, myocardial infarction, or ischaemic strokeResult — go to the resultDifference −4 percentage points 90% CI −10 to 3Authors' conclusion
To our knowledge, this is the first randomised trial to compare P2Y12 inhibitor strategies specifically in patients with AMI-CS. Cangrelor achieved effective platelet inhibition more frequently than crushed ticagrelor at the end of primary percutaneous coronary intervention. Non-inferiority of cangrelor versus crushed ticagrelor was not demonstrated for the primary 30-day clinical endpoint. These trial findings can inform future trials of P2Y12 inhibition strategies in patients with AMI-CS.
Study context
- Population
- Patients older than 18 years with acute myocardial infarction complicated by cardiogenic shock (AMI-CS)randomly assigned, 137 [23%] were female
- Participants
- 605 participants
- Comparison
- Intravenous cangrelor vs crushed oral ticagrelor
- Cangrelorn = 298
- Ticagrelorn = 307
- Primary endpoint
- Primary clinical endpoint: death, myocardial infarction, or ischaemic stroke
- Follow-up
- 30 days
Methodological detailsnon-inferiority, 29 hospitals across five European countries, stratified randomisation (1:1)
- Non-inferiority
- 29 hospitals across five European countries
- Stratified randomisation (1:1)
Primary result
As reported in the abstract
Difference
−4 percentage points
90% CI −10 to 3
P = 0.13 for non-inferiority
Events by treatment group
Further findings
Primary laboratory endpoint: platelet reactivity index of less than 50% at the end of primary percutaneous coronary intervention
P < 0.0001
- Primary laboratory endpoint: platelet reactivity index of less than 50% at the end of primary percutaneous coronary intervention: analysed in 56 (19%) patients in the cangrelor group and 68 (22%) in the ticagrelor group
Follow-up completeness · 1 year
- No surviving patients were lost to the 1-year follow-up
Safety
Major bleeding · 30 days
Original publication
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