This study aims to evaluate the impact on myocardial reperfusion and residual thrombotic burden of adding Cangrelor -a potent and immediate P2Y12 inhibitor- to ticagrelor in primary PCI patients with high on ticagrelor platelet reactivity compared to standard of care with ticagrelor alone.
Despite the use of potent P2Y12 inhibitor such as ticagrelor, half of the patients presented high platelet reactivity (HPR) at the time of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). HPR has been associated with impaired myocardial reperfusion. Myocardial reperfusion, assessed using myocardial blush grade, is a strong prognostic factor associated with infarct size and mortality. Antiplatelet therapy intensification using a potent and immediate P2Y12 inhibitor such as Cangrelor according a point-of-care platelet function test has not been studied in the acute phase of STEMI. This study aims to evaluate the impact on myocardial reperfusion and residual thrombotic burden of adding Cangrelor to ticagrelor in primary PCI patients with high on ticagrelor platelet reactivity compared to standard of care with ticagrelor alone.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
128
Cangrelor perfusion (started before PCI) with intravenous bolus of 30 microgram/kg, followed by a perfusion of 4 microgram/kg/min during 2 hours or until the end of the PCI if longer
primary PCI without cangrelor
CAEN University Hospital
Caen, France
Grade of myocardial blush
myocardial blush grade from 0 to 3 (normal)
Time frame: during procedure
percentage of residual thrombus burden
intrastent residual thrombus burden assessed by optical coherence tomography
Time frame: during procedure
measure of platelet reactivity
Platelet reactivity using VerifyNow after PCI for patients with basal platelet reaction unit\>208
Time frame: during procedure
troponin
peak value
Time frame: day 1
infarct size and no reflow on MRI
Time frame: during hospitalization assessed up to 7 days
clinical outcomes
death, new myocardial infarction, stent thrombosis, new revascularization, stroke, major bleeding
Time frame: during hospitalization assessed up to 7 days
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