Document Type

Conference Proceeding

Publication Date


Publication Title

JACC Cardiovasc Interv


Introduction: Little is known about the use of cangrelor in patients with MI who are treated with an oral P2Y12 inhibitor upstream prior to cardiac catheterization.

Methods: CAMEO (Cangrelor in Acute MI: Effectiveness and Outcomes) is a 12-hospital observational registry studying platelet inhibition for MI patients undergoing cardiac cath. Upstream oral P2Y12 inhibition was defined as receipt of an oral P2Y12 inhibitor within 24 hours prior to hospitalization or in-hospital prior to cath. Among cangrelor-treated patients, we compared bleeding after cangrelor use through 7 days post-discharge between patients with and w/o upstream oral P2Y12 inhibitor exposure using logistic regression. We examined rates of bleeding among patients with a shorter (<1 hour) vs. longer (1-3 hours or >3 hours) duration between the last oral dose and cangrelor start.

Results: Among 1,775 cangrelor-treated MI patients, 433 (24.4%) had upstream oral P2Y12 inhibitor treatment prior to cath. Of these, 165 patients (38%) started cangrelor within 1 hour, 109 (25%) between 1-3 hours, and 134 (31%) > 3 hours after the in-hospital oral P2Y12 inhibitor dose. Cangrelor-treated patients who received upstream treatment were more likely to have a history of prior PCI, MI, PAD, and diabetes and to be clopidogrel-treated (all p<0.01) compared w/o upstream treatment. There was no significant difference in risk of bleeding among cangrelor-treated patients with and w/o upstream oral P2Y12 inhibitor exposure (Table). While bleeding events were higher in patients with longer delays to cangrelor initiation, bleeding risk was not significant after adjustment (Table).

Conclusions: Bleeding risk was not observed to be higher in cangrelor-treated patients after upstream oral P2Y12 inhibitor exposure compared with patients treated with cangrelor w/o upstream oral P2Y12 inhibitor exposure.





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