Transitioning from Cangrelor to Oral P2Y12 Inhibitors in Patients with ACS: Insights from the ARCANGELO Study

Aims: The present analysis of the ARCANGELO study aims to investigate the effect of switching to different oral P2Y12 inhibitors when using cangrelor during PCIs in patients with ACS. Methods: Out of the 995 patients meeting the criteria for this investigation, 138 transitioned to Clopidogrel (CLO), 127 to rasugrel (PRA), and 730 to Ticagrelor (TICA). Compared to the patients on PRA or TICA, users of CLO were older (median (Q1-Q3) 74(64-81) years CLO, 59(54-65) years PRA, 65(56-73) TICA; p<0.0001), had more comorbidities (37.0% CLO, 17.3% PRA, 18.9% TICA, p<0.0001), and had more frequently an NSTEMI diagnosis (68.1% CLO vs 33.1% PRA vs 35.9% TICA, p<0.0001). Results: Five moderate bleeds were recorded without any severe episodes. There were no significant differences in the bleeding rate when switching to the different oral P2Y12 inhibitors (2.2% CLO, 5.3% TICA, 7.9% PRA, p = 0.0705) while different incidences of MACEs (4.3% CLO, 1.1% TICA, 0% PRA, p = 0.0113) and NACEs (4.3% CLO, 1.8% TICA, 0% PRA, p=0.0321) were observed during the 30 days of the study. Conclusion: The use of cangrelor and the switch to any oral P2Y12 inhibitor in compliance with the EU SmPC is safe, with a low risk of ischemic events in routine clinical practice.