Cardiogenic shock following acute myocardial infarction remains a high-risk condition with complex hemostatic management. A recent propensity score-matched study compared ticagrelor and clopidogrel in patients receiving dual antiplatelet therapy to evaluate 30-day mortality and major cardiovascular events. These findings were presented at the European Society of Cardiology Conference 2025.

A single-center retrospective study compared ticagrelor with clopidogrel in 88 propensity-matched patients receiving dual antiplatelet therapy. Patients had a mean age of 60.5 years. Among 88 patients, 44% were classified as SCAI Class C shock, and 47.7% received mechanical circulatory support, including intra-aortic balloon pump, VA-ECMO, or Impella.

At 30 days, mortality was 34.1% in the ticagrelor group versus 54.6% with clopidogrel. Ticagrelor also reduced major adverse cardiovascular events (34.1% vs 56.8%). Among patients on mechanical support, ticagrelor showed a similar trend, though statistical significance was not reached. Major bleeding rates were comparable between groups.

These results suggest that ticagrelor may offer a survival advantage in high-risk patients with cardiogenic shock after myocardial infarction, without increasing bleeding risk. Further prospective studies are needed to confirm these observations.