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Kordis P, Berden J, Mikuz U, Noc M. Immediate Platelet Inhibition Strategy for Comatose Out-of-Hospital Cardiac Arrest Survivors Undergoing Percutaneous Coronary Intervention and Mild Therapeutic Hypothermia. J Clin Med 2024; 13:2121. [PMID: 38610886 PMCID: PMC11012382 DOI: 10.3390/jcm13072121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI) and target temperature management (TTM) are at increased risk of stent thrombosis (ST), partly due to delayed platelet inhibition even with more potent P2Y12 agents. We hypothesized that periprocedural cangrelor would induce immediate platelet inhibition, bridging the "P2Y12 inhibition gap". Methods: In our pilot study, we randomized 30 comatose OHCA patients undergoing PCI and TTM (32-34 °C) into cangrelor and control groups. Both groups received unfractioned heparin, acetylsalicylic acid, and ticagrelor via enteral tube. The cangrelor group also received an intravenous bolus of cangrelor followed by a 4 h infusion. Platelet inhibition was measured using VerifyNow® and Multiplate® ADP at baseline and 1, 3, 5, and 8 h post PCI. Results: Patient characteristics did not differ between groups. VerifyNow® showed significantly decreased platelet reactivity with cangrelor at 1 h (30 vs. 221 PRU; p < 0.001) and 3 h (24 vs. 180 PRU; p < 0.001), with differences at 5 and 8 h. Similarly, the proportion of patients with high on-treatment platelet reactivity (HPR) in the cangrelor group was significantly lower at 1 h (0% vs. 67%; p < 0.001) and 3 h (0% vs. 47%; p = 0.007). Multiplate® ADP was also decreased at 1 h (14 vs. 48 U; p < 0.001) and 3 h (11 vs. 42 U; p = 0.001), with no difference at 5 and 8 h. The occurrence of bleeding events was similar in both groups. Conclusions: Cangrelor safely induced immediate and profound platelet inhibition. We observed no significant drug-drug interaction with ticagrelor.
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Affiliation(s)
- Peter Kordis
- Center for Intensive Internal Medicine, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (P.K.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Jernej Berden
- Center for Intensive Internal Medicine, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (P.K.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Ursa Mikuz
- Center for Intensive Internal Medicine, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (P.K.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Marko Noc
- Center for Intensive Internal Medicine, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (P.K.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Zeymer U, Lober C, Richter S, Olivier CB, Huber K, Haring B, Schwimmbeck P, Andrassy M, Akin I, Cuneo A, Desch S, Thiele H, Geisler T. Cangrelor in patients with percutaneous coronary intervention for acute myocardial infarction after cardiac arrest and/or with cardiogenic shock. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:462-463. [PMID: 37042356 DOI: 10.1093/ehjacc/zuad041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/05/2023] [Accepted: 03/30/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany
- Stiftung, Institut für Herzinfarktforschung Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany
| | - Christiane Lober
- Stiftung, Institut für Herzinfarktforschung Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany
| | | | | | | | - Bernhard Haring
- Kardiologie, Universitätsklinikum Homburg-Saar, Homburg/Saar, Germany
| | | | | | - Ibrahim Akin
- Kardiologie, Universitätsklinikum Mannheim, Kardiologie, Mannheim, Germany
| | | | - Steffen Desch
- Kardiologie: Innere Medizin III, Universitäres Herzzentrum Leipzig, Leipzig, Germany
| | - Holger Thiele
- Kardiologie: Innere Medizin III, Universitäres Herzzentrum Leipzig, Leipzig, Germany
| | - Tobias Geisler
- Universitätsklnikum Tübingen, Innere Medizin III, Tübingen, Germany
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Brami P, Picard F, Seret G, Fischer Q, Pham V, Varenne O. Intracoronary imaging in addition to coronary angiography for patients with out-of-hospital cardiac arrest: More information for better care? Arch Cardiovasc Dis 2023; 116:272-281. [PMID: 37117094 DOI: 10.1016/j.acvd.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/30/2023]
Abstract
About 70% of out-of-hospital cardiac arrests are related to an ischaemic heart disease in Western countries. Percutaneous coronary intervention has been shown to improve the prognosis of survivors when an unstable coronary lesion is identified as the potential cause of the cardiac arrest. Acute complete coronary occlusion is often demonstrated among patients with ST-segment elevation on electrocardiogram after the return of spontaneous circulation. In patients without ST-segment elevation, routine coronary angiography has been shown to be not superior to conservative management. However, an electrocardiogram-based decision to perform immediate coronary angiography could be insufficient to identify unstable coronary lesions, which are frequently associated with intermediate coronary stenosis. Intracoronary imaging can be helpful to detect plaque rupture or erosion and intracoronary thrombus, but could also lead to better stent implantation, and help to reduce the risk of stent thrombosis. In patients with coronary lesions without the instability characteristic, conservative management should be the default strategy, and a search for another cause of the cardiac arrest should be systematic. In the present review, we sought to describe the potential benefit of intracoronary imaging in patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Pierre Brami
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France
| | - Gabriel Seret
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Quentin Fischer
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France; Centre d'expertise sur la mort subite (CEMS), 75015 Paris, France.
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Kordis P, Bozic Mijovski M, Berden J, Steblovnik K, Blinc A, Noc M. Cangrelor for comatose survivors of out-of-hospital cardiac arrest undergoing percutaneous coronary intervention: the CANGRELOR-OHCA study. EUROINTERVENTION 2023; 18:1269-1271. [PMID: 36484623 PMCID: PMC10015287 DOI: 10.4244/eij-d-22-00675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/11/2022] [Indexed: 03/18/2023]
Affiliation(s)
- Peter Kordis
- Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | | | - Jernej Berden
- Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Klemen Steblovnik
- Faculty of Medicine, University of Ljubljana, Slovenia
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Ales Blinc
- Faculty of Medicine, University of Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Center, Ljubljana, Slovenia
| | - Marko Noc
- Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
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