Giuseppe Gargiulo; Plinio Cirillo; Luca Sperandeo; Domenico Castiello; Lina Manzi; Imma Forzano; Domenico Florimonte; Fiorenzo Simonetti; Mario Canonico; Marisa Avvedimento; Roberta Paolillo; Alessandra Spinelli; Federica Buongiorno; Luigi Serafino; Carmen Anna Maria Spaccarotella; Anna Franzone; Raffaele Piccolo; Eugenio Stabile; Marco Valgimigli; Giovanni Esposito

doi:10.4244/EIJ-D-24-00757

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Original Research

DOI: 10.4244/EIJ-D-24-00757

Pharmacodynamic effects of cangrelor in patients with acute or chronic coronary syndrome undergoing percutaneous coronary intervention: the POMPEII Registry

Giuseppe Gargiulo¹, MD, PhD; Plinio Cirillo¹, MD, PhD; Luca Sperandeo¹, MD; Domenico Simone Castiello¹, MD; Lina Manzi¹, MD; Imma Forzano¹, MD; Domenico Florimonte¹, MD; Fiorenzo Simonetti¹, MD; Mario Enrico Canonico¹, MD, PhD; Marisa Avvedimento¹, MD, PhD; Roberta Paolillo¹, PhD; Alessandra Spinelli¹, BSc; Federica Buongiorno¹, MD; Luigi Di Serafino¹, MD, PhD; Carmen Anna Maria Spaccarotella¹, MD; Anna Franzone¹, MD, PhD; Raffaele Piccolo¹, MD, PhD; Eugenio Stabile², MD, PhD; Marco Valgimigli³, MD, PhD; Giovanni Esposito¹, MD, PhD

Abstract

Background: Cangrelor is approved for oral P2Y₁₂ inhibitor-naïve patients undergoing percutaneous coronary intervention (PCI). Pharmacodynamic (PD) investigations in various clinical settings, with various assays, have shown contrasting data in terms of the extent of platelet inhibition and rates of high residual platelet reactivity (HRPR).

Aims: We aimed to assess the PD effects of cangrelor in all patients receiving it during PCI.

Methods: PharmacOdynaMic Effects of Cangrelor in PatiEnts wIth Acute or chronIc Coronary Syndrome Undergoing Percutaneous Coronary Intervention (POMPEII Registry; ClinicalTrials.gov: NCT04790032) is an investigator-initiated, prospective study assessing PD effects at 4 timepoints with 3 assays. Clinical outcomes at 30 days were also assessed.

Results: From March 2021 to June 2024, 150 patients undergoing PCI and receiving cangrelor were enrolled (64 patients underwent elective PCI; 30 had non-ST-elevation acute coronary syndrome; and 56 had ST-segment elevation myocardial infarction [STEMI], of whom 24 were pretreated with ticagrelor). Most patients switched from cangrelor to either clopidogrel or ticagrelor. Inhibition of platelet aggregation was moderate during cangrelor infusion (light transmittance aggregometry with adenosine diphosphate 20 μM: 57.6±16.5%), with rates of 3.2% for HRPR and 1.3% for bailout tirofiban. Rates of HRPR were relevant at 3 h (37.9%) and 4-6 h (15.3%), and HRPR occurred significantly more frequently in patients switching to clopidogrel compared with ticagrelor. Rates of ischaemic and bleeding events were low.

Conclusions: Cangrelor provided effective platelet inhibition in most patients with ACS or CCS undergoing PCI, including those with STEMI who were pretreated with ticagrelor. Switching from cangrelor to an oral P2Y₁₂ inhibitor, mainly clopidogrel, exposed a large number of patients to a variable period of on-treatment HRPR.

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