Clinical practice of cangrelor use in Austrian ACS patients: a real-world multicenter registry

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Introduction Cangrelor is the only available intravenous P2Y 12 inhibitor and is primarily used in patients with acute coronary syndromes (ACS), especially those presenting with cardiac arrest without prior oral P2Y 12 therapy. Despite guideline recommendations and evidence from the CHAMPION trials, real-world data on its use remain limited. This study evaluated real-world cangrelor use in patients with ACS, with a particular focus on transition strategies from oral P2Y₁₂ inhibitor therapy and associated treatment patterns. Methods We performed a retrospective cross-sectional analysis using data from a nationwide Austrian registry including 10 high-volume percutaneous coronary intervention (PCI) centers over a 7-year period. The timing of concomitant antiplatelet and anticoagulant therapy was assessed. Major adverse cardiovascular events (MACE) and bleeding complications occurring during the index hospitalization, for up to 7 days, were recorded. Results A total of 626 patients were consecutively enrolled over a 7-year period. Cangrelor was administered for a median duration of 2.5 h. Marked inter-center differences were observed in transition strategies and pre-procedural antithrombotic therapy. Overall, 69% of patients received aspirin and heparin alone, whereas 31% also received an oral P2Y 12 inhibitor before cangrelor initiation. Among patients transitioned to a thienopyridine, 9 (6%) received clopidogrel and 6 (4%) received prasugrel before cangrelor discontinuation. Major bleeding (BARC ≥3) occurred in 46 patients (7%), without observed differences according to the timing of oral P2Y 12 inhibitor administration. Conclusion This nationwide real-world study highlights considerable variability in the clinical use of Cangrelor and its integration with oral P2Y 12 inhibitors.

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