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Patients who survive cardiogenic shock after a heart attack are among the highest-risk patients and have a significant risk of developing heart failure. Any improvement of heart function should reduce their risk of developing heart failure in the long term.

A trial led by Mount Sinai researchers demonstrates the potential benefit of powerful intravenous blood thinners (antiplatelet drugs) in reducing complications in these complex cases. For heart attack patients who develop cardiogenic shock—the most serious complication of a heart attack—cangrelor, a potent intravenous blood thinner, resulted in better recovery of heart function when compared to oral antiplatelet therapy. The findings are published in The Lancet journal.

This is the first randomized trial of double antiplatelet therapy in heart attacks complicated by cardiogenic shock.

Researchers randomized 605 patients who underwent cardiac stent procedures. Before the procedure, 298 were given cangrelor and 307 were given crushed ticagrelor, an oral antiplatelet medication. The researchers wanted to see how well the two different drugs stopped blood from clotting.

The primary laboratory endpoint of platelet reactivity index of less than 50% (the benchmark doctors use to prove blood thinners are effectively working) was analyzed in 56 patients from the cangrelor group and 68 from the ticagrelor group. This benchmark was achieved in 100% of patients in the cangrelor group and 22% in the ticagrelor group.

In the imaging substudy, cangrelor was much better at protecting the heart from microvascular obstruction.

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