Outcome data on the use of cangrelor in older patients is limited. This post-hoc analysis of the ARCANGELO study aims to assess bleeding and ischemic outcomes with the transition from cangrelor to any oral P2Y12 inhibitors in age-stratified subgroups (≥75 years - older, <75 years - younger) of patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Out of 995 patients, 215 (21.6%) were older, 115 (11.6%) of whom were aged ≥ 80 years. Presentation with ST-elevation myocardial infarction was less frequent among older than younger patients (52.6% vs 62.1%, p=0.0119). At 30 days post-PCI, rates of the study's primary endpoint of overall bleeding defined according to the Bleeding Academic Research Consortium (BARC) were not significantly different between the two age subgroups (4.6% in the younger vs. 7.4% in the older, p=0.1179). Rates of major adverse cardiac events, defined as the composite of death, myocardial infarction, ischemia-driven revascularization, and stent thrombosis, were significantly lower among younger than older patients (0.9% vs. 3.3%, p=0.0170). Intraprocedural thrombotic events occurring in the 48 hours post-PCI occurred in similar proportions between subgroups (1.4% vs 1.4%, p=1.000). In conclusion, these data suggest that the use of cangrelor with transition to any oral P2Y12 inhibitor is a safe and effective antithrombotic treatment in older patients undergoing PCI for ACS in the setting of routine clinical practice.
Keywords: Cangrelor; MACEs; acute coronary syndrome; bleeding; elderly.
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