Madrid, Spain – 31 August 2025: Compared with crushed ticagrelor, intravenous cangrelor provided immediate, effective platelet inhibition, with no increase in major bleeding and lower mortality rates in patients with acute myocardial infarction and cardiogenic shock, according to late-breaking research presented in a Hot Line session today at ESC Congress 2025.1
Cardiogenic shock is a life-threatening condition in which the heart cannot pump enough blood to meet the body's needs. It is present in around 4.6% of patients admitted to hospital for acute myocardial infarction (MI) and is associated with in-hospital mortality rates of 44%.2 Reperfusion using primary percutaneous coronary intervention (PCI) remains the only universal therapeutic approach that improves prognosis.
“Achieving early and effective platelet inhibition is vital for reperfusion at the microcirculatory level in patients with MI complicated with cardiogenic shock. However, major randomised trials on the efficacy and safety of antiplatelet drugs have not included patients with cardiogenic shock. Currently, oral crushed ticagrelor tablets are given; however, the parenteral, direct-acting, reversible P2Y12 inhibitor, cangrelor, may address issues that occur during cardiogenic shock, including poor absorption and impaired liver metabolism,” explained Principal Co-Investigator, Professor Zuzana Motovska from the Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia. “The DAPT-SHOCK-AMI trial – comparing IV cangrelor with crushed ticagrelor – is the first-ever randomised study evaluating the efficacy and safety of antiplatelet agents in this setting.”
This double-blind, placebo-controlled randomised trial was conducted at 29 sites in Czechia, France, Germany, Poland and Slovakia. Key inclusion criteria were acute MI with an indication for emergency primary PCI and cardiogenic shock that fulfilled at least two of: a) systolic blood pressure <90 mmHg in the absence of hypovolaemia, b) need for vasopressor and/or inotropic therapy and c) signs of organ hypoperfusion. Patients were randomised 1:1 to receive IV cangrelor (IV bolus of 30 μg/kg followed by a continuous infusion at 4 μg/kg) or oral ticagrelor (crushed tablets at a 180-mg loading dose and then a maintenance dose of 90 mg twice daily). In the cangrelor group, 30 minutes before the end of the cangrelor infusion, 180 mg of ticagrelor (crushed tablets) was administered, followed by a maintenance dose of 90 mg twice daily. Cangrelor-placebo and ticagrelor-placebo were administered in the same form as their active counterparts. The study medication was administered to all enrolled patients on top of concomitant aspirin. In total, 605 patients were randomised. The mean age was 65 years and 22.6% were women.
The primary laboratory endpoint (defined as platelet reactivity index <50% at the end of primary PCI) was achieved in 100% of patients with cangrelor and in 22.1% with ticagrelor (p for superiority<0.0001).
At 30 days, the primary clinical endpoint was not met: 37.6% of patients in the cangrelor group and 41.0% of patients in the ticagrelor group experienced all-cause death, MI or stroke (difference −3.5%, 95% confidence interval [CI] −11.2% to 4.3%; p for noninferiority=0.13).
The incidence of all-cause mortality at 12 months was 43.6% in the cangrelor group and 49.2% in the ticagrelor group (difference: −5.6%; 95% CI −13.5% to 2.4%), while the incidence of cardiovascular mortality was 26.8% and 33.2%, respectively ( −6.4%; 95% CI −13.7% to 0.9%).
The incidence of major bleeding at 30 days was 6.4% in the cangrelor group and 5.2% in the ticagrelor group (p=0.53).
Improvements were noted in primary PCI outcomes, periprocedural complications, early reinfarction and stent thrombosis rates with cangrelor compared with ticagrelor.
Principal Co-Investigator, Professor Deepak Bhatt from the Icahn School of Medicine at Mount Sinai, New York, USA, concluded: “Compared with crushed ticagrelor, IV cangrelor provided immediate, effective platelet inhibition and improved several secondary and exploratory clinical outcomes without increasing major bleeding. If verified in larger trials, IV cangrelor could represent a major advancement in the treatment of cardiogenic shock.”
Notes to editor
This press release accompanies both a presentation and an ESC press conference at
ESC Congress 2025.
It does not necessarily reflect the opinion of the European Society of Cardiology.
Funding: This study was funded by non-commercial research grants from the Charles University, the Agency for Health Research (Ministry of Health) in Czechia and the European Union programme, Next Generation EU.
Disclosures: Professor Motovska reports the following relationships: Research funding related to the implementation of the DAP-SHOCK-AMI study: the Ministry of Health of the Czech Republic Grant No. NV19-02-00086; the Charles University Czech Republic: Research Programs PROGRESS Q 38 and COOPERATIO – Cardiovascular Science, Research Support from Donatio Universitatis Carolinae, the Charles University 4EU+ mini-grant (No. 4EU+/23/F1/04); Program EXCELES, ID Project No. LX22NPO5104 - Funded by the European Union – Next Generation EU. Advisory board member: AstraZeneca (2023), Bayer (2018), Boehringer Ingelheim (2023), Chiesi (2021), Sanofi (2024). Research funds or honoraria from: Czech Society of Cardiology, Idorsia, Janssen, Novo Nordisk, TIMI Study Group/Brigham and Women's Hospital, RITA-MI 2 Grant agreement ID: 899991, HORIZON 2020-EU 3.1.1. Meeting attendance support: Czech Society of Cardiology, Charles University, EU Program EXCELES (Project No. LX22NPO5104). Professor Bhatt reports the following relationships: Advisory Board: Angiowave, Antlia Bioscience, Bayer, Boehringer Ingelheim, CellProthera, Cereno Scientific, E-Star Biotech, High Enroll, Janssen, Level Ex, McKinsey, Medscape Cardiology, Merck, NirvaMed, Novo Nordisk, Repair Biotechnologies, Stasys, Tourmaline Bio; Board of Directors: American Heart Association New York City, Angiowave (stock options), Bristol Myers Squibb (stock), DRS.LINQ (stock options), High Enroll (stock); Consultant: Alnylam, Altimmune, Broadview Ventures, Corcept Therapeutics, Corsera, GlaxoSmithKline, Hims, SERB, SFJ, Summa Therapeutics, Worldwide Clinical Trials; Data Monitoring Committees: Acesion Pharma, Assistance Publique-Hôpitaux de Paris, Baim Institute for Clinical Research, Boston Scientific (Chair, PEITHO trial), Cleveland Clinic, Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ABILITY-DM trial, funded by Concept Medical; for ALLAY-HF, funded by Alleviant Medical), Novartis, Population Health Research Institute; Rutgers University (for the NIH-funded MINT Trial); Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Chair, ACC Accreditation Oversight Committee), Arnold and Porter law firm (work related to Sanofi/Bristol-Myers Squibb clopidogrel litigation), Baim Institute for Clinical Research (AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), CSL Behring (AHA lecture), Duke Clinical Research Institute, Engage Health Media, HMP Global (Editor in Chief, Journal of Invasive Cardiology), Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Oakstone CME (Course Director, Comprehensive Review of Interventional Cardiology), Philips (Becker's Webinar on AI), Population Health Research Institute, WebMD (CME steering committees), Wiley (steering committee); Other: Clinical Cardiology (Deputy Editor); Progress in Cardiovascular Diseases (Deputy Editor); Patent: Sotagliflozin (named on a patent for sotagliflozin assigned to Brigham and Women's Hospital who assigned to Lexicon; neither I nor Brigham and Women's Hospital receive any income from this patent); Research Funding: Abbott, Acesion Pharma, Afimmune, Alnylam, Amarin, Amgen, AstraZeneca, Atricure, Bayer, Boehringer Ingelheim, Boston Scientific, CellProthera, Cereno Scientific, Chiesi, Cleerly, CSL Behring, Faraday Pharmaceuticals, Fractyl, Idorsia, Janssen, Javelin, Lexicon, Lilly, Medtronic, Merck, MiRUS, Moderna, Novartis, Novo Nordisk, Pfizer, PhaseBio, Regeneron, Reid Hoffman Foundation, Roche, Sanofi, Stasys, 89Bio; Royalties: Elsevier (Editor, Braunwald’s Heart Disease); Site Co-Investigator: Cleerly.
References and notes:
1‘DAPT-SHOCK-AMI trial: Cangrelor in cardiogenic shock’ presented during HOT LINE 7 on 31 August 2025 at 17:00 to 17:10 in Madrid (Main Auditorium).
2Hunziker L, Radovanovic D, Jeger R, et al. Twenty-year trends in the incidence and outcome of cardiogenic shock in AMIS Plus Registry. Circ Cardiovasc Interv. 2019;12:e007293.
ESC Press Office
Tel: +33 661401884
Email: press@escardio.org
The hashtag for ESC Congress 2025 is #ESCCongress
Follow us on LinkedIn @European Society of Cardiology News
Journalists are invited to become accredited and register here.
Check out the ESC Media and Embargo Policy.
It is the world’s largest gathering of cardiovascular professionals, disseminating ground-breaking science both onsite in Madrid and online – from 29 August to 1 September 2025. Explore the scientific programme. More information is available from the ESC Press Office at press@escardio.org.
About the European Society of Cardiology
The ESC brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.