Rapid platelet inhibition with cangrelor has theoretical advantages in acute myocardial infarction (AMI) complicated by cardiogenic shock or cardiac arrest, but real-world safety data remain limited. An analysis presented at the American Heart Association (AHA) 2025 Scientific Sessions evaluated in-hospital outcomes associated with cangrelor use during percutaneous coronary intervention (PCI) for AMI complicated by cardiogenic shock or cardiac arrest. 

The study used data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry, which captures all PCI procedures at non-federal hospitals across Michigan. The propensity-matched cohort included 1,850 patients treated between April 2018 and December 2024. The mean age was 65 years, 67.5% were male, and 64.5% presented with ST-segment elevation myocardial infarction. Cardiogenic shock occurred in 62.2%, cardiac arrest in 64.6%, and both conditions in 26.8%. A total of 370 patients received cangrelor, while 1,480 did not. Patients treated with glycoprotein IIb/IIIa inhibitors were excluded.

Cangrelor use was associated with a higher incidence of major bleeding compared with no cangrelor (13.5% vs 9.0%; p = 0.024) and a higher requirement for blood transfusion (26.2% vs 17.8%; p < 0.001). Minor bleeding rates did not differ significantly (8.2% vs 7.1%; p = 0.527). In-hospital mortality was similar between groups at approximately 30% (p = 0.950).

In PCI for AMI complicated by cardiogenic shock or cardiac arrest, cangrelor did not reduce in-hospital mortality but was associated with significantly higher rates of major bleeding and transfusion. These findings highlight the importance of careful risk assessment when selecting intravenous antiplatelet therapy in this high-risk population.