{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:16:28Z","timestamp":1788916588800,"version":"build-2803163510"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T00:00:00Z","timestamp":1720483200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"MOH | National Medical Research Council","award":["NMRC\/CTGIITE\/0005\/2016"],"award-info":[{"award-number":["NMRC\/CTGIITE\/0005\/2016"]}]},{"name":"MOH | National Medical Research Council","award":["MOH-STaR21jun-0003"],"award-info":[{"award-number":["MOH-STaR21jun-0003"]}]},{"name":"MOH | National Medical Research Council","award":["NMRC CG21APR1006"],"award-info":[{"award-number":["NMRC CG21APR1006"]}]},{"name":"MOH | National Medical Research Council","award":["NMRC\/CG21APRC006"],"award-info":[{"award-number":["NMRC\/CG21APRC006"]}]},{"DOI":"10.13039\/501100019705","name":"EU-CARDIOPROTECTION","doi-asserted-by":"crossref","award":["IG16225"],"award-info":[{"award-number":["IG16225"]}],"id":[{"id":"10.13039\/501100019705","id-type":"DOI","asserted-by":"crossref"}]},{"name":"EU-METAHEART","award":["CA22169"],"award-info":[{"award-number":["CA22169"]}]}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,7,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The administration of intravenous cangrelor at reperfusion achieves faster onset of platelet P2Y12 inhibition than oral ticagrelor and has been shown to reduce myocardial infarction (MI) size in the preclinical setting. We hypothesized that the administration of cangrelor at reperfusion will reduce MI size and prevent microvascular obstruction in patients with ST-segment\u2013elevation MI undergoing primary percutaneous coronary intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      This was a phase 2, multicenter, randomized, double-blind, placebo-controlled clinical trial conducted between November 2017 to November 2021 in 6 cardiac centers in Singapore. Patients were randomized to receive either cangrelor or placebo initiated before the primary percutaneous coronary intervention procedure on top of oral ticagrelor. The key exclusion criteria included presenting &lt;6 hours of symptom onset; previous MI and stroke or transient ischemic attack; on concomitant oral anticoagulants; and a contraindication for cardiovascular magnetic resonance. The primary efficacy end point was acute MI size by cardiovascular magnetic resonance within the first week expressed as percentage of the left ventricle mass (%LVmass). Microvascular obstruction was identified as areas of dark core of hypoenhancement within areas of late gadolinium enhancement. The primary safety end point was Bleeding Academic Research Consortium\u2013defined major bleeding in the first 48 hours. Continuous variables were compared by Mann-Whitney\n                      <jats:italic toggle=\"yes\">U<\/jats:italic>\n                      test (reported as median [first quartile\u2013third quartile]), and categorical variables were compared by Fisher exact test. A 2-sided\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 209 recruited patients, 164 patients (78%) completed the acute cardiovascular magnetic resonance scan. There were no significant differences in acute MI size (placebo, 14.9% [7.3\u201322.6] %LVmass versus cangrelor, 16.3 [9.9\u201324.4] %LVmass;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.40) or the incidence (placebo, 48% versus cangrelor, 47%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.99) and extent of microvascular obstruction (placebo, 1.63 [0.60\u20134.65] %LVmass versus cangrelor, 1.18 [0.53\u20133.37] %LVmass;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.46) between placebo and cangrelor despite a 2-fold decrease in platelet reactivity with cangrelor. There were no Bleeding Academic Research Consortium\u2013defined major bleeding events in either group in the first 48 hours.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Cangrelor administered at the time of primary percutaneous coronary intervention did not reduce acute MI size or prevent microvascular obstruction in patients with ST-segment\u2013elevation MI given oral ticagrelor despite a significant reduction of platelet reactivity during the percutaneous coronary intervention procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03102723.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.124.068938","type":"journal-article","created":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T09:15:16Z","timestamp":1715678116000},"page":"91-101","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Effect of Cangrelor on Infarct Size in ST-Segment\u2013Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention: A Randomized Controlled Trial (The PITRI Trial)"],"prefix":"10.1161","volume":"150","clinical-trial-number":[{"clinical-trial-number":"nct03102723","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1985-1783","authenticated-orcid":true,"given":"Heerajnarain","family":"Bulluck","sequence":"first","affiliation":[{"name":"Leeds Teaching Hospital, National Health Service Trust, United Kingdom (H.B.)."},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (H.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Hua","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Cardiology (J.H.C., J.B., C.Y.C., S.T.L., V.P., X.M.P., J.C.K.T., A.W., Y.K.K., J.W.C.T.), National Heart Centre Singapore."},{"name":"Cardiovascular &amp; Metabolic Disorders Program (J.H.C., M.C., D.J.H.), Duke\u2013National University of Singapore Medical 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