Evidence map›Paper›PMID 41457245›Full record

SynthesisCritical care (London, England)2025

Cangrelor in critically ill patients with cardiogenic shock or post-cardiac arrest undergoing percutaneous coronary intervention: a systematic review and meta-analysis.

Hendrianus Hendrianus, Young-Hoon Jeong, Sang Yeub Lee, Jun Hwan Cho, Jinhwan Jo, Diana A Gorog, Jacek Kubica, Udaya S Tantry, Paul A Gurbel, Sang-Wook Kim

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Hendrianus HendrianusHeart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea.
Young-Hoon JeongDepartment of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea. goodoctor@naver.com.
Sang Yeub LeeHeart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea.
Jun Hwan ChoHeart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea.
Jinhwan JoHeart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea.
Diana A GorogCardiovascular Division, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
Jacek KubicaDepartment of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
Udaya S TantrySinai Center for Thrombosis Research and Drug Development, Sinai Hospital, Baltimore, MD, USA.
Paul A GurbelSinai Center for Thrombosis Research and Drug Development, Sinai Hospital, Baltimore, MD, USA.
Sang-Wook KimHeart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEvidence for cangrelor in critically ill patients remains extremely limited, despite heightened thrombotic risk from delayed oral P2Y12 inhibitor effects post- percutaneous coronary intervention (PCI). We aim to assess intravenous (IV) cangrelor’s efficacy and safety in patients with cardiogenic shock (CS) or post-cardiac arrest (CA) undergoing PCI.

methodsThis systematic review and meta-analysis (PROSPERO number: CRD420251126926) searched PubMed, Embase, and the Cochrane library to identify studies comparing adjunctive cangrelor with oral P2Y12 inhibitor during PCI in patients with CS or CA, published up until August 31, 2025. Efficacy endpoints included all-cause mortality, cardiovascular (CV) mortality, stent thrombosis, myocardial infarction (MI), stroke, and TIMI 3 flow achievement; safety endpoints were major and minor bleeding episodes.

resultsA total of 12 studies including 4,537 patients were identified. Compared with the conventional treatment, adjunctive cangrelor reduced all-cause mortality overall (RR, 0.90; 95% CI, 0.82–0.98); the effect was significant in CS (RR, 0.86; 95% CI, 0.78–0.96) but not in CA (RR, 0.94; 95% CI, 0.74–1.18). No significant differences were observed in CV mortality (RR, 0.96; 95% CI, 0.76–1.22), stent thrombosis (RR, 0.72; 95% CI, 0.34–1.53), MI (RR, 0.83; 95% CI; 0.44–1.57), or stroke (RR, 1.83; 95% CI, 0.89–3.74). In addition, cangrelor was associated with higher rates of post-PCI TIMI 3 flow (RR, 1.14; 95% CI, 1.01–1.29). Major bleeding was not significantly increased overall (RR, 1.37; 95% CI, 0.95–1.97), but in controlled studies the risk was relatively increased (RR, 1.50; 95% CI, 1.10–2.05). Subgroup analyses of patients with CS supported by mechanical circulatory support, out-of-hospital CA, and CA managed with targeted temperature management showed no significant differences in clinical outcomes across all endpoints.

conclusionsIV cangrelor was associated with reduced mortality following PCI in hemodynamically unstable patients, with the most pronounced benefit observed in those with CS, alongside improved coronary flow. These findings support its role as a valuable alternative when oral P2Y12 inhibitor administration is not feasible, pending confirmation of overall clinical benefit in large-scale randomized trials.

Indexed as

Adenosine MonophosphateHeart ArrestPercutaneous Coronary InterventionShock, CardiogenicCritical IllnessHumansPurinergic P2Y Receptor AntagonistsAdenosine MonophosphatecangrelorPurinergic P2Y Receptor AntagonistsCangrelorCardiac arrestCardiogenic shockP2Y12 inhibitorPercutaneous coronary intervention

Identifiers

PMID41457245
PMCPMC12860006

What OpenQuestion holds

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LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.