Compared with crushed ticagrelor, intravenous (IV) cangrelor provided immediate and effective platelet inhibition with no increase in major bleeding and lower mortality rates in patients with acute myocardial infarction (MI) and cardiogenic shock. However, researchers presenting the findings from the DAPT-SHOCK-AMI trial at ESC Congress 2025, said intravenous cangrelor was not shown to be noninferior to crushed ticagrelor for the composite clinical endpoint of all-cause death, MI or stroke at 30 days.

The trial randomized 605 patients to receive IV cangrelor (IV bolus of 30 μg/kg followed by a continuous infusion at 4 μg/kg) or oral crushed ticagrelor tablets (180-mg loading dose followed by a maintenance dose of 90 mg twice daily). The mean age of participants was 65 years and 22.6% were women.

The primary laboratory endpoint (defined as platelet reactivity index <50% at the end of primary PCI) was achieved in 100% of patients with cangrelor compared with 22.1% with ticagrelor (p for superiority<0.0001). However, the primary clinical endpoint of all-cause death, MI or stroke was not met at 30 days, with 37.6% of patients in the cangrelor group and 41% of patients in the ticagrelor group experiencing all-cause death, MI or stroke (p for noninferiority=0.13). The incidence of major bleeding at 30 days was 6.4% in the cangrelor group and 5.2% in the ticagrelor group. Researchers also observed improvements in primary PCI outcomes, periprocedural complications, early reinfarction and stent thrombosis rates with cangrelor compared with ticagrelor.

"Achieving early and effective platelet inhibition is vital for reperfusion at the microcirculatory level in patients with MI complicated with cardiogenic shock. However, major randomized trials on the efficacy and safety of antiplatelet drugs have not included patients with cardiogenic shock," said Principal Co-Investigator Zuzana Motovska, MD. Principal Co-Investigator Deepak L. Bhatt, MD, MPH, MBA, FACC, added that if DAPT-SHOCK-AMI results are able to be verified in larger trials, IV cangrelor could represent a major advancement in cardiogenic shock treatment.