Acute cardiac care & resuscitation
Multimodality Cardiac Imaging Substudy of the DAPT-SHOCK-AMI Randomized Trial: Echocardiographic and Cardiac Magnetic Resonance Assessment of Cangrelor versus Crushed Ticagrelor in Cardiogenic Shock Complicating Acute Myocardial Infarction
Primary result · Microvascular obstruction (MVO) on acute CMRResult — go to the resultAdjusted odds ratio 0.27 95% CI 0.08–0.98Authors' conclusion
In AMI-CS, serial multimodality imaging characterized microvascular, tissue-level, and functional injury over 1 year. Cangrelor was associated with less acute MVO, lower remote native T1, and more complete recovery of LV function than crushed ticagrelor, without a difference in infarct size; these hypothesis-generating findings suggest differences in the microcirculation and non-infarcted myocardial injury but do not establish a treatment mechanism.
Study context
- Population
- Patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) at prespecified imaging sites208 enrolled in echocardiography, 93 enrolled in cardiac magnetic resonance (CMR), 81 patients (40 and 41) underwent both modalities · Echocardiography enrolled 208 · CMR enrolled 93 · Both modalities 81
- Comparison
- Intravenous cangrelor versus crushed oral ticagrelor
Methodological detailsserial echocardiography and cardiac magnetic resonance, blinded core laboratories, covariate-adjusted logistic or linear regression, not separately powered
- Serial echocardiography and cardiac magnetic resonance
- Blinded core laboratories
- Covariate-adjusted logistic or linear regression
- Not separately powered
Primary result
Microvascular obstruction (MVO) on acute CMR
Adjusted odds ratio
0.27
95% CI 0.08–0.98
P = 0.023
As reported in the abstract
Secondary outcomes
Native T1 of the remote myocardium · 1 year
LVEF increase on echocardiography (% of the acute value) · over 1 year
LVEF increase on CMR · over 1 year
- Native T1 of the remote myocardium: P=0.005
- LVEF increase on echocardiography (% of the acute value): adjusted P=0.046
- LVEF increase on CMR: P=0.027
Infarct size
- Did not differ between the arms
Global longitudinal strain (GLS), E/e', left atrial volume · over 1 year
- Greater improvement in GLS, lower E/e', and less left atrial enlargement with cangrelor
All imaging parameters · 1 month
- No parameter differed between the arms
Original publication
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