Cangrelor in Acute and Chronic Coronary Syndromes: The POMPEII Registry

Platelet inhibition during and after coronary angioplasty is essential to prevent peri- and post-procedural ischemic events. To that end, cangrelor, an intravenous P2Y12 receptor inhibitor, offers rapid onset and offset, making it an attractive option for patients with acute coronary syndromes (ACS) or chronic coronary syndromes (CCS) undergoing percutaneous coronary intervention (PCI). However, there is limited evidence on its pharmacodynamic impact in clinical practice, particularly in scenarios involving various pretreatment alternatives and during the transition to oral antiplatelet agents.

The POMPEII study, led by Gargiulo et al., is a single-center prospective registry that included 150 patients treated with cangrelor during PCI. The aim was to assess its pharmacodynamic effect at different time points and using multiple methods (LTA, MEA, VerifyNow).

Patients included had ACS (56 with ST-segment elevation myocardial infarction [STEMI], 30 with non-ST-segment elevation [NSTE]-ACS) and CCS (64 patients). Overall, 23% were women and the average patient age was 66.7 years. All patients received aspirin, unfractionated heparin, and cangrelor (a 30-μg/kg bolus followed by a 4-μg/kg/min infusion for 2 hours) before the start of the procedure. Twenty-four STEMI patients were pretreated with ticagrelor.

During cangrelor infusion, platelet aggregation inhibition (PAI) was moderate (Light Transmission Aggregometry [LTA] 20 µM, ADP: 57.6±16.5%), with a low prevalence of high residual platelet reactivity (HRPR <5%). However, after drug discontinuation and s switch to oral P2Y12 inhibitors, there was a significant increase in HRPR at 3 and 4–6 hours (up to 37.9% and 15.3%, respectively), particularly in those receiving clopidogrel. In contrast, transitioning to ticagrelor showed better platelet inhibition profiles and lower HRPR, even in previously treated patients.

Read also: Hyper-Adducted Right Radial Access vs. Left Radial Access: Aiming for Lower Daily Radiation Exposure.

In the subgroup of STEMI patients pretreated with ticagrelor, cangrelor proved effective in achieving adequate platelet inhibition, with no evidence of adverse drug interactions.

At 30 days, clinical events were infrequent: one cardiovascular death (0.7%), one periprocedural myocardial infarction (0.7%), and an overall bleeding rate of 12% (predominantly BARC 1-2).

Conclusions

The POMPEII registry provides evidence on the pharmacodynamic profile of cangrelor, demonstrating its effectiveness in periprocedural platelet inhibition. Furthermore, during the transition to oral P2Y12 inhibitors, pretreatment with ticagrelor may help reduce residual platelet reactivity.

Original Title: Pharmacodynamic effects of cangrelor in patients with acute or chronic coronary syndrome undergoing percutaneous coronary intervention: the POMPEII Registry.

Reference: Gargiulo G, Cirillo P, Sperandeo L, Castiello DS, Manzi L, Forzano I, Florimonte D, Simonetti F, Canonico ME, Avvedimento M, Paolillo R, Spinelli A, Buongiorno F, Serafino LD, Spaccarotella CAM, Franzone A, Piccolo R, Stabile E, Valgimigli M, Esposito G. Pharmacodynamic effects of cangrelor in patients with acute or chronic coronary syndrome undergoing percutaneous coronary intervention: the POMPEII Registry. EuroIntervention. 2025 May 16;21(10):560-570. doi: 10.4244/EIJ-D-24-00757. PMID: 40375762; PMCID: PMC12063553.