The use of intravenous antiplatelet therapy during primary percutaneous coronary intervention (PPCI) is not fully standardized. The aim is to evaluate the effectiveness and safety of periprocedural intravenous administration of cangrelor or tirofiban in a contemporary ST-segment elevation myocardial infarction (STEMI) population undergoing PPCI. This was a multicenter prospective cohort study including consecutive STEMI patients who received cangrelor or tirofiban during PPCI at seven Italian centers. The primary effectiveness measure was the angiographic evidence of thrombolysis in myocardial infarction (TIMI) flow < 3 after PPCI. The primary safety outcome was the in-hospital occurrence of BARC (Bleeding Academic Research Consortium) 2–5 bleedings. The study included 627 patients (median age 63 years, 79% males): 312 received cangrelor, 315 tirofiban. The percentage of history of bleeding, pulmonary edema and cardiogenic shock at admission was comparable between groups. Patients receiving cangrelor had lower ischemia time compared to tirofiban. TIMI flow before PPCI and TIMI thrombus grade were comparable between groups. At propensity score-weighted regression analysis, the risk of TIMI flow < 3 was significantly lower in patients treated with cangrelor compared to tirofiban (adjusted OR: 0.40; 95% CI: 0.30–0.53). The risk of BARC 2–5 bleeding was comparable between groups (adjusted OR:1.35; 95% CI: 0.92–1.98). These results were consistent across multiple prespecified subgroups, including subjects stratified for different total ischemia time, with no statistical interaction. In this real-world multicenter STEMI population, the use of cangrelor was associated with improved myocardial perfusion assessed by coronary angiography after PPCI without increasing clinically-relevant bleedings compared to tirofiban.

Graphical abstract

中文翻译：

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ST段抬高型心肌梗死初次经皮冠状动脉介入治疗患者的静脉抗血小板治疗

初次经皮冠状动脉介入治疗 (PPCI) 期间静脉抗血小板治疗的使用尚未完全标准化。目的是评估在接受 PPCI 的当代 ST 段抬高型心肌梗死 (STEMI) 人群中围手术期静脉注射坎格瑞洛或替罗非班的有效性和安全性。这是一项多中心前瞻性队列研究，包括在七个意大利中心在 PPCI 期间接受坎格雷洛或替罗非班的连续 STEMI 患者。主要有效性衡量标准是 PPCI 后心肌梗塞 (TIMI) 血流 < 3 时溶栓的血管造影证据。主要安全性结果是院内发生 BARC（出血学术研究联盟）2-5 次出血。该研究包括 627 名患者（中位年龄 63 岁，79% 为男性）：其中 312 名患者接受坎格雷洛治疗，315 名患者接受替罗非班治疗。入院时出血、肺水肿和心源性休克病史的比例在各组之间具有可比性。与替罗非班相比，接受坎格雷洛的患者缺血时间较短。 PPCI 前的 TIMI 血流和 TIMI 血栓分级在组间具有可比性。在倾向评分加权回归分析中，与替罗非班相比，接受坎格雷洛治疗的患者 TIMI 血流 < 3 的风险显着降低（调整后 OR：0.40；95% CI：0.30-0.53）。各组之间 BARC 2-5 出血的风险相当（调整后 OR：1.35；95% CI：0.92-1.98）。这些结果在多个预先指定的亚组中是一致的，包括按不同总缺血时间分层的受试者，没有统计交互作用。在这个真实世界的多中心 STEMI 人群中，与替罗非班相比，坎格雷洛的使用与 PPCI 后冠状动脉造影评估的心肌灌注改善相关，且没有增加临床相关出血。

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