In patients with acute myocardial infarcation (AMI) and cardiogenic shock, intravenous cangrelor gives immediate, effective platelet inhibition and lowers mortality rates compared with crushed tigacrelor, the DAPT-SHOCK-AMI study shows. These results were presented during a Hot Line session on Sunday at the European Society of Cardiology (ESC) Congress 2025 in Madrid by Professor Zuzana Motovska, of the Charles University and University Hospital Kralovske Vinohrady, Prague. Cardiogenic shock complicates AMI (AMI-CS) by making it more difficult for patients to absorb antiplatelet drugs. AMI-CS also has higher ischemic and death rates. Randomized trials investigating P2Y12 inhibitors often don’t include CS patients. The investigators in the randomized, double-blind, international DAPT SHOCK AMI (Dual Antiplatelet Therapy for SHOCK patients with Acute Myocardial Infarction) study examined the use of crushed ticagrelor versus intravenous cangrelor in patients with AMI-CS. The laboratory primary endpoint for this trial was a platelet reactivity index (VASP) <50% at the end of primary angioplasty. The clinical primary endpoint for the trial was all-cause mortality, MI or ischemic stroke at 30-days. Investigators noted the key secondary efficacy endpoint: death, MI, urgent revascularization of the infarct-related artery, stent thrombosis or ischemic stroke. The key secondary safety endpoint was major bleeding ≥ Bleeding Academic Research Consortium (BARC) 3b. A total of 605 patients (298 in intravenous cangrelor group, mean age=65 years, 77.4% men; 307 in crushed ticagrelor group, mean age=66 years, 77.9% male) were analyzed between August 1, 2018, and January 19, 2024. Patients who received cangrelor met the primary endpoint at 100%, while patients who received ticagrelor was 22.1% (p for superiority<0.0001). The primary clinical endpoint at 30-days was 37.6% of cangrelor patients and 41.0% of ticagrelor patients (95% confidence interval [CI]: -11.2% to 4.3%, p for noninferiority=0.13). All-cause death at 1-year follow-up was 43.6% in the cangrelor group and 49.2% in the ticagrelor group (95% CI: -13.5% to 2.4%), and cardiovascular mortality was 26.8% and 33.2% in the two groups (95% CI: -13.7% to 0.9%). Major bleeding at 30 days was similar between groups (p=0.53). The investigators also highlighted improvements in primary PCI outcomes, periprocedural complications, early reinfarction and stent thrombosis in patients who received cangrelor compared with ticagrelor. “Larger trials are needed to confirm the findings related to numerically lower [cardiovascular] mortality at one year, which if verified, could represent a major advancement in the treatment of cardiogenic shock,” Dr. Motovska concluded during her presentation on Sunday. Image Credit: European Society of Cardiology (ESC) Congress 2025 Press Office. Image Caption: Professor Zuzana Motovska discusses the DAPT SHOCK AMI trial during a Press Conference at the European Society of Cardiology (ESC) Congress 2025.