Intravenous cangrelor infusion in elderly patients undergoing percutaneous coronary intervention: a subanalysis of the icarus registry

Abstract Aims To assess the clinical characteristics and compare in-hospital outcomes of elderly and non-elderly patients receiving cangrelor in the peri-percutaneous coronary intervention (PCI) phase. Methods Consecutive patients treated with cangrelor in 7 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high-bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. Elderly patients were defined if age was ≥75 years at the time of PCI. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours and throughout the hospital stay. Independent predictors of the primary endpoint were also assessed. Results Out of 551 patients undergoing PCI with cangrelor between January 2019 and August 2022, 174 (32%) were elderly. Mean age was 81±5 vs. 61±8 years in elderly vs. non-elderly patients (p<0.001). Female sex (32% vs. 21%, p=0.006), atrial fibrillation (20% vs. 5%, p<0.001), chronic kidney disease (30% vs. 6%, p<0.001) and heart failure (14% vs. 8%, p=0.041) were more frequent in the elderly group, whereas presentation with acute coronary syndrome (ACS) was less frequent (69% vs. 83%, p=0.001). Elderly patients received shorter cangrelor infusion (122±25 vs. 134±43 minutes, p=0.001) and were more frequently administered with clopidogrel after PCI (50% vs. 19%, p<0.001). At 48 hours, elderly patients had higher rates of NACE (13% vs. 6%, p=0.006) and BARC 2, 3 or 5 bleeding (11% vs. 5%, p=0.013), whereas the rates of other 48-hour and in-hospital clinical endpoints did not differ. At multivariable analysis, age ≥75 years (odds ratio [OR] 1.07, 95% CI 1.02-1.12, p=0.004), major anemia (OR 1.10, 95% CI 1.005-1.22, p=0.038), ACS at presentation (OR 1.08, 95% CI 1.03-1.14), femoral access (OR 1.13, 95% CI 1.06-1.22) and cardiogenic shock (OR 1.35, 95% CI 1.21-1.50) independently predicted the occurrence of 48-hour NACE. Conclusions Advanced age is a distinctive risk feature among patients receiving intravenous cangrelor in the peri-PCI phase. Elderly patients had higher rates of adverse events at 48 hours, with advanced age (≥75 years) being an independent predictor of NACE.