Background In clinical trials,
cangrelor has been shown to reduce
percutaneous coronary intervention-related ischemic complications without increasing major
bleeding. This study was performed to examine
cangrelor use and transition to oral P2Y12 inhibitors in routine clinical practice. Methods and Results The CAMEO (
Cangrelor in Acute
Myocardial Infarction: Effectiveness and Outcomes) registry is a multicenter, retrospective observational study of platelet inhibition strategies for patients with
myocardial infarction undergoing
percutaneous coronary intervention. In phase 1, data were collected on consecutive patients with
myocardial infarction (n=482) treated with any P2Y12 inhibitor to understand
cangrelor use by hospital. In phase 2, data were collected in a 2:1 (
cangrelor-: non-
cangrelor-treated) ratio of patients with
myocardial infarction (n=873). In phase 1,
cangrelor use varied across hospitals (overall, 50.4% [range, 6.0%-100%]). Of patients receiving
cangrelor in both phases (n=819), 3.3% received either the bolus or infusion only.
Cangrelor was infused for a median of 121 (76-196) minutes; and 38.3% received an infusion for <2 hours. Most patients transitioned from
cangrelor to
ticagrelor (
ticagrelor, 85.3%;
clopidogrel, 9.5%;
prasugrel, 5.2%). Many patients (16.4%) had a >1-hour gap between
cangrelor cessation and oral P2Y12 inhibitor initiation; this was highest among those transitioned to
clopidogrel (56.6% versus 34.5%
prasugrel versus 10.8%
ticagrelor; P<0.001). Only 27.3% were dosed with
cangrelor and transitioned to an oral P2Y12 inhibitor in a fashion consistent with the pivotal trials and US Food and Drug Administration label. Conclusions This multicenter registry demonstrated interhospital variability in how
cangrelor was administered and transitioned to an oral P2Y12 inhibitor. These findings highlight opportunities for optimization of
cangrelor dosing, infusion duration, and
transition of care from the catheterization laboratory to the ward setting.