New Study Explores Intravenous Cangrelor for Treating Cardiogenic Shock in Heart Attack Patients

Recent research presented at the ESC Congress 2025 highlights the potential benefits of using intravenous cangrelor as an antiplatelet therapy in patients suffering from cardiogenic shock due to acute myocardial infarction (AMI). Unlike the standard oral crushed ticagrelor, cangrelor offers immediate and effective platelet inhibition, which is crucial during reperfusion therapy. Cardiogenic shock is a critical condition affecting approximately 4.6% of AMI patients, with a high in-hospital mortality rate of about 44%. Effective early intervention is vital for improving outcomes.

The DAPT-SHOCK-AMI trial, a double-blind, placebo-controlled study, involved 605 patients across multiple European sites. Participants with AMI and cardiogenic shock were randomly assigned to receive either intravenous cangrelor or oral ticagrelor, in addition to aspirin. The results showed that cangrelor achieved complete platelet reactivity suppression at the end of primary PCI, outperforming ticagrelor significantly. Although there was no significant difference in the primary clinical endpoint at 30 days—including death, MI, or stroke—the trial indicated trends favoring cangrelor, with lower mortality at 12 months and fewer periprocedural complications.

Importantly, cangrelor did not increase the risk of major bleeding compared to ticagrelor, making it a promising option for this high-risk group. Experts suggest that intravenous cangrelor could become a major advancement in the treatment of cardiogenic shock, especially if larger studies confirm these findings. This innovation addresses the limitations of oral antiplatelet medications, such as impaired absorption during shock states, potentially improving survival rates and reducing complications in patients with severe heart attacks.