Cangrelor versus Ticagrelor in Patients Treated with Primary Percutaneous Coronary Intervention: Impact on Platelet Activity, Myocardial Microvascular Function and Infarct Size: A Randomized Controlled Trial

Research output: Contribution to journalArticlepeer-review


  • Salahaddin Ubaid
  • Thomas J Ford
  • Colin Berry
  • Heather M Murray
  • Benjamin Wrigley
  • Nazish Khan
  • Angel L Armesilla
  • Jon N Townend
  • Saib S Khogali
  • Shahzad Munir
  • Joe Martins
  • Sandeep S Hothi
  • Elisa J McAlindon
  • James M Cotton

Colleges, School and Institutes

External organisations

  • Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom.
  • British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
  • Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
  • Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
  • School of Pharmacy, University of Wolverhampton, Wolverhampton, United Kingdom.
  • 1 Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.2 Liver Unit, Birmingham Children's Hospital, Birmingham, United Kingdom.3 Department of Histopathology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.


BACKGROUND:  Oral P2Y12 inhibitors take more than 2 hours to achieve full effect in healthy subjects and this action is further delayed in patients with acute myocardial infarction. Intravenous P2Y12 inhibition might lead to more timely and potent anti-platelet effect in the context of emergency primary angioplasty, improving myocardial recovery.

OBJECTIVES:  This article compares the efficacy of intravenous cangrelor versus ticagrelor in a ST-elevation myocardial infarction (STEMI) population treated with primary percutaneous coronary intervention (PPCI).

MATERIALS AND METHODS:  In an open-label, prospective, randomized controlled trial, 100 subjects with STEMI were assigned 1:1 to intravenous cangrelor or oral ticagrelor. The co-primary endpoints were platelet P2Y12 inhibition at infarct vessel balloon inflation time, 4 and 24 hours. Secondary endpoints included indices of coronary microcirculatory function: index of microvascular resistance (IMR), initial infarct size (troponin at 24 hours) and final infarct size at 12 weeks (cardiac magnetic resonance). Secondary endpoints included indices of coronary microcirculatory function (index of microvascular resistance [IMR]), initial infarct size (troponin at 24 hours), final infarct size at 12 weeks (cardiac magnetic resonance), corrected thrombolysis in myocardial infarction (TIMI) frame count, TIMI flow grade, myocardial perfusion grade, and ST-segment resolution ( NCT02733341).

RESULTS:  P2Y12 inhibition at first balloon inflation time was significantly greater in cangrelor-treated patients (cangrelor P2Y12 reaction unit [PRU] 145.2 ± 50.6 vs. ticagrelor 248.3 ± 55.1). There was no difference in mean PRU at 4 and 24 to 36 hours post-dosing. IMR, final infarct size, angiographic and electrocardiographic measures of reperfusion were all similar between groups.

CONCLUSION:  Cangrelor produces more potent P2Y12 inhibition at the time of first coronary balloon inflation time compared with ticagrelor. Despite this enhanced P2Y12 inhibition, coronary microvascular function and final infarct size did not differ between groups.

Bibliographic note

Georg Thieme Verlag KG Stuttgart · New York.


Original languageEnglish
Pages (from-to)1171-1181
Number of pages11
JournalThrombosis and Haemostasis
Issue number7
Publication statusPublished - Jul 2019


  • Adenosine Monophosphate/analogs & derivatives, Aged, Blood Platelets/drug effects, Blood Vessels/drug effects, Cells, Cultured, Female, Humans, Male, Microcirculation/drug effects, Middle Aged, Myocardial Infarction/drug therapy, Myocardium/metabolism, Percutaneous Coronary Intervention, Platelet Activation, Platelet Function Tests, Receptors, Purinergic P2Y12/metabolism, Regional Blood Flow/drug effects, Ticagrelor/therapeutic use