DAPT-SHOCK-AMI trial, 605 patients: cangrelor suppressed platelets more often than ticagrelor in shock

The randomized DAPT-SHOCK-AMI trial compared two antiplatelet drugs in patients with myocardial infarction complicated by cardiogenic shock, according to pravda.ru. The study enrolled 605 patients who underwent stenting, a procedure that restores patency of the coronary arteries pravda.rupravda.rupravda.ruOpen source ↗. Antiplatelet drugs prevent platelets from sticking together and forming clots.

The trial compared intravenous cangrelor with ticagrelor, which is taken as a tablet. In this study a crushed form of ticagrelor was used to speed up absorption.

Cardiogenic shock is a condition in which the heart suddenly cannot pump enough blood to meet the body's needs. It often develops as a complication of myocardial infarction, and about half of such patients die within a year. Until now, the main recognized forms of care have been emergency restoration of blood flow in the arteries and mechanical pumps.

Platelet inhibition and microvascular obstruction

In laboratory tests, the target level of platelet inhibition was reached in 100% of patients in the cangrelor group and in 22% in the ticagrelor group pravda.rupravda.rupravda.ruOpen source ↗. In patients receiving cangrelor, the risk of microvascular obstruction was 73% lower. This complication occurs when fragments of clots or plaques block small vessels of the heart muscle.

Heart function at one year

After one year of follow-up, the pumping function of the heart was assessed with ultrasound and MRI. Ejection fraction, the volume of blood the heart expels, improved noticeably more in the cangrelor group than in patients who took ticagrelor. The report adds that the choice of drug strategy at the time of stenting may improve the prognosis for recovery of the heart muscle and reduce the likelihood of later heart failure.

Long-term follow-up of the participants is continuing and is meant to clarify the remote effects of the treatment. The researchers note that large studies of this kind are difficult to conduct because of the severity of the patients' condition.