心源性休克中康瑞洛的使用：CAMEO 登记的启示。

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure Pub Date : 2024-10-01 DOI:10.1016/j.cardfail.2024.08.003

JENNIFER RYMER MD, MBA, MHS , CAYLA PICHAN MD , COURTNEY PAGE MA , BROOKE ALHANTI PhD , DEEPAK L. BHATT MD, MPH, MBA , AJAR KOCHAR MD, MHS , DOMINICK J. ANGIOLILLO MD, PhD , MIGUEL DIAZ MD , NEIL J. WIMMER MD, MSc , RON WAKSMAN MD , LAWRENCE ANG MD , RICHARD BACH MD , RONALD JENKINS MD , HIJRAH EL-SABAE PharmD , LEO BROTHERS MPH , E. MAGNUS OHMAN MBBCh , W. SCHUYLER JONES MD , JEFFREY B. WASHAM PharmD , TRACY Y. WANG MD, MHS, MSc , DENNIS NARCISSE MD , MIR B. BASIR DO

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引用次数: 0

摘要

简介人们对心肌梗死（MI）伴有心源性休克（CS）的患者使用坎格雷洛的情况知之甚少：CAMEO（坎格列罗在急性心肌梗死中的应用：疗效与结果）是一项多中心观察登记项目，旨在评估心肌梗死患者的血小板抑制情况。我们研究了CS患者输注坎格雷罗的持续时间以及从坎格雷罗过渡到口服P2Y12抑制剂的时间。我们还评估了主要心血管不良事件（MACEs）和出血风险，并根据剂量持续时间、过渡时间和口服 P2Y12 抑制剂的效力进行了分层：在2352例接受坎格雷乐治疗的心肌梗死患者中，有249例为CS患者。在CS患者中，16人（6.4%）接受了 "桥接 "输注剂量，202人（81.1%）接受了PCI坎格雷洛输注剂量，30人（12.0%）同时接受了两种输注剂量。CS患者的中位年龄为66岁；32%为女性；21%为黑人患者；35%患有糖尿病；19%接受了血栓切除术；59%接受了机械循环支持（MCS）（35%主动脉内球囊泵，27%Impella）。CS患者的中位输液持续时间为3.9（2-21.5小时），所有接受坎格雷乐治疗的患者的中位输液持续时间为2（1.6-3.1小时）。CS患者从服用康格列转为口服P2Y12抑制剂的中位持续时间为0.1（-0.5-21.0小时）。在多变量模型中，慢性肺部疾病和使用 MCS 与更长时间的坎格雷洛输注（定义为 > 3.9 小时）相关。在接受坎格雷乐治疗的 CS 患者中，24.1% 的患者发生了出血事件，41.8% 的患者发生了 MACE 事件。经调整后，坎格雷洛输注持续时间越长，出血风险越高（P＜0.05）：结论：CS患者坎格雷洛输注的中位持续时间更长。CS患者使用MCS与更长的坎格雷洛输注时间有关。还需要进一步研究以了解 CS 患者使用抗血小板药物的药效学。

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The Use of Cangrelor in Cardiogenic Shock: Insights from the CAMEO Registry

Introduction

Little is known about the use of cangrelor in patients with myocardial infarction (MI) presenting with cardiogenic shock (CS).

Methods

CAMEO (Cangrelor in Acute MI: Effectiveness and Outcomes) is a multicenter observational registry evaluating platelet inhibition in patients with MI. We examined the duration of cangrelor infusion and the amount of time to transition from cangrelor to an oral P2Y₁₂ inhibitor in patients with CS. We also assessed major adverse cardiovascular events (MACEs) and bleeding risks, stratified by dosage duration, time to transition and oral P2Y₁₂ inhibitor potency.

Results

Among 2352 cangrelor-treated patients with MI, 249 patients were in CS. Among the patients with CS, 16 (6.4%) received the “bridge” infusion dose, 202 (81.1%) the PCI cangrelor infusion dose, and 30 (12.0%) had a combination of both infusion doses. Patients with CS had a median age of 66 years; 32% were women; 21% were Black patients; 35% had diabetes; 19% received thrombectomy; and 59% received mechanical circulatory support (MCS) (35% intra-aortic balloon pump, 27% Impella). The median duration of infusion was 3.9 (2–21.5 hours) in patients with CS and was 2 (1.6–3.1 hours) for all cangrelor-treated patients. The median duration of transition from cangrelor to oral P2Y₁₂ inhibitor administration was 0.1 (-0.5–21.0 hours) for patients with CS. In multivariable modeling, chronic lung disease and the use of MCS and was associated with longer cangrelor infusions (defined as > 3.9 hours). Among cangrelor-treated patients with CS, 24.1% of these patients had a bleeding event, and 41.8% had a MACE event. After adjustment, a longer cangrelor infusion duration was associated with increased risk of bleeding (P < 0.05).

Conclusions

The median duration of cangrelor infusion was longer for patients presenting with CS. Use of MCS was associated with longer cangrelor infusion durations in patients with CS. Further work is needed to understand the pharmacodynamics of antiplatelet agents in patients with CS.

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来源期刊

Journal of Cardiac Failure 医学-心血管系统

CiteScore

7.80

自引率

8.30%

发文量

653

审稿时长

21 days

期刊介绍： Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure - pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment.