https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; 2Klinikum der Ruhr-Universität Bochum Medizinische Klinik II, Kardiologie Bochum, Deutschland
Background
Cardiogenic shock (CS) is a life-threatening complication of acute coronary syndromes (ACS). Early revascularization targeting the culprit lesion improves survival. Following percutaneous coronary intervention (PCI), antiplatelet therapy is recommended to prevent thrombotic complications associated with stenting. However, the efficacy and safety of antiplatelet therapy in CS patients are poorly understood, as these patients are often excluded from randomized trials.
Methods
This analysis included patients with infarct-related CS treated with antiplatelet therapy after PCI, categorized into three groups based on their P2Y12 inhibitor treatment (clopidogrel, prasugrel, or ticagrelor). The primary endpoint was 30-day mortality. Secondary endpoints included renal replacement therapy (RRT), pulmonary embolism, in-hospital cardiac arrest (IHCA), stroke, limb infarction, and gastrointestinal bleeding.
Results
Among the 223 patients with infarct-related CS who underwent PCI, 35.4% received clopidogrel (n=79), 35% received prasugrel (n=78), and 29.6% received ticagrelor (n=66). Thirty-day mortality was highest in the ticagrelor group (63.6%), compared to clopidogrel (55.7%) and prasugrel (39.7%; p=0.013). Patients receiving ticagrelor also had higher rates of RRT (40.9%) compared to clopidogrel (26.9%) and prasugrel (19.2%; p=0.015). Limb infarction was observed more frequently in the ticagrelor group (9.1%) than in the clopidogrel group (5.1%; p=0.032), while no limb infarctions occurred in the prasugrel group. IHCA was more common in patients receiving ticagrelor (30.3%) compared to clopidogrel (16.5%) and prasugrel (12.8%; p=0.022). No significant differences were observed between groups in rates of pulmonary embolism, stroke, and gastrointestinal bleeding.
Conclusion
In this real-world cohort, 30-day mortality and in-hospital complications were higher in infarct-related CS patients treated with ticagrelor compared to those treated with clopidogrel or prasugrel. These findings suggest that further research is needed to determine the optimal antiplatelet therapy in this high-risk population.