Use of cangrelor in patients with reduced renal function: Post-hoc analysis from the ARCANGELO study

Background: The use of cangrelor in patients with reduced renal function has never been investigated. This post-hoc analysis of the itAlian pRospective Study on CANGrELOr (ARCANGELO) study aims to assess bleeding and ischemic outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) and transitioning from cangrelor to any oral P2Y12 inhibitors in clinical practice in subgroups stratified by renal function. Methods: The patients were stratified according to their Estimated-Glomerular-Filtration-Rate (eGFR) value (<60 [LGFR] vs ≥60 [HGFR] mL/min). Bleeding Academic Research Consortium (BARC)-defined outcomes, Major Adverse Cardiac Events (MACEs), Intraprocedural Thrombotic Events (IPTEs), and other safety parameters were assessed in the two subgroups. Results: Of 770 patients included in this post-hoc analysis, 136 (17.7%) had LGFR. These patients had a higher frequency of comorbidities, including diabetes (34.6% vs. 20.0%, p = 0.0004) and atrial fibrillation (10.3% vs. 2.4%, p = 0.0001) than those HGFR. A higher rate of LGFR patients had NSTEMI (54.4% vs. 44.5%) (p = 0.0350) and a multi-vessel coronary artery disease (67.6%) than HGFR ones (48.3%, p < 0.0001). While rates of bleeding, IPTE, and MACEs were similarly low in LGFR and HGFR patients during the 30-day observation period, a higher proportion of LGFR patients (2.2%) experienced BARC type 3–5 (moderate-severe) bleeding compared to HGFR patients (0.2%; p = 0.0188). The type and frequency of MACEs and adverse events in this fragile population were similar to those observed in the overall patients treated with cangrelor. Conclusions: These data suggest that the transition from cangrelor to any oral P2Y12 inhibitor is a safe and effective treatment in patients with acute coronary syndrome and reduced renal function undergoing PCI in the setting of routine clinical practice.