This double-blind trial randomized 605 patients with myocardial infarction complicated by cardiogenic shock to cangrelor or crushed ticagrelor. Death, myocardial infarction, or ischaemic stroke at 30 days occurred in 38% versus 41%; non-inferiority was not demonstrated (difference −4 percentage points; 90% CI −10 to 3). Among patients tested, platelet reactivity index below 50% at the end of primary percutaneous coronary intervention was achieved in 100% versus 22%. Major bleeding at 30 days occurred in 6% versus 5%, respectively.
Cangrelor produced more frequent effective platelet inhibition in the tested subset, but clinical non-inferiority to crushed ticagrelor was not established. The laboratory result does not establish a clinical benefit.
Study limitation: The platelet endpoint was assessed in only 19% and 22% of the respective groups, limiting interpretation of this surrogate finding.
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