Cangrelor versus crushed ticagrelor in acute myocardial infarction complicated by cardiogenic shock (DAPT-SHOCK-AMI): a randomised, double-blind trial.

In AMI complicated by cardiogenic shock, cangrelor produced platelet reactivity index <50% in 100% versus 22% with crushed ticagrelor at end of primary PCI.

• Why it matters: Oral P2Y 12 inhibitors may be poorly absorbed in AMI-CS, leaving patients at high ischaemic and mortality risk and creating uncertainty about optimal short-term antiplatelet strategy.
• What they did: In a double-blind trial at 29 hospitals in five European countries, 605 adults with AMI-CS were randomized to cangrelor (30 μg/kg bolus then 4 μg/kg per min) or crushed ticagrelor (180 mg), with laboratory and 30-day clinical endpoints.
• The result: At 30 days, death, myocardial infarction, or ischaemic stroke occurred in 38% with cangrelor and 41% with ticagrelor (difference -4 percentage points; non-inferiority not shown, P non-inferiority=0·13), while major bleeding was 6% vs 5%.

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