This prespecified imaging substudy compared intravenous cangrelor with crushed oral ticagrelor in patients with acute myocardial infarction complicated by cardiogenic shock. Acute microvascular obstruction, the primary imaging endpoint, was evaluable in 60 patients and was less frequent with cangrelor (adjusted odds ratio 0.27, 95% confidence interval 0.08–0.98). Infarct size did not differ between groups, while remote myocardial native T1 was lower with cangrelor at one year. Left ventricular ejection fraction improved more with cangrelor over one year on both imaging modalities; no measured parameter differed between groups at one month.
The imaging findings suggest differences in microvascular injury and ventricular recovery, but remain hypothesis-generating. They do not establish a treatment mechanism or a patient-centred clinical benefit.
Study limitation: The substudy was not separately powered, and only 60 patients had evaluable imaging for the primary endpoint.
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