Conference: American Heart Association Scientific Sessions 2026 (AHA 2026)
Presentation: Featured Science – "Multimodality Cardiac Imaging Substudy of the DAPT-SHOCK-AMI Randomized Trial: Echocardiographic and Cardiac Magnetic Resonance Assessment of Cangrelor vs. Crushed Ticagrelor in Cardiogenic Shock Complicating Acute Myocardial Infarction"
Substudy simultaneously published in Circulation – "Multimodality Cardiac Imaging Substudy of the DAPT-SHOCK-AMI Randomized Trial: Echocardiographic and Cardiac Magnetic Resonance Assessment of Cangrelor versus Crushed Ticagrelor"
Main study simultaneously published in The Lancet – "Cangrelor Versus Crushed Ticagrelor in Acute Myocardial Infarction Complicated by Cardiogenic Shock (DAPT-SHOCK-AMI): A Randomized, Double-Blind Trial"
Senior and corresponding author: Deepak L. Bhatt, MD, MPH, MBA, FACC, FAHA, FESC, MSCAI, Director of Mount Sinai Fuster Heart Hospital and the Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai.
*The work at AHA 2026 was presented by the first author Zuzana Motovska, MD, PhD, from Charles University and University Hospital, in Prague, Czechia.
Study's bottom line: 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.
Why this study is important: 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. This trial demonstrates the potential benefit of powerful intravenous blood thinners (antiplatelet drugs) in reducing complications in these complex cases.
Why this study is unique: This is the first randomized trial of double antiplatelet therapy in heart attacks complicated by cardiogenic shock.
How the study was conducted: Researchers randomized 605 patients who underwent cardiac stent procedures. Before the procedures, 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.
Study results: The primary laboratory endpoint of platelet reactivity index of less than 50 percent (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 percent of patients in the cangrelor group, and 22 percent in the ticagrelor group.
In the imaging substudy, cangrelor was much better at protecting the heart from microvascular obstruction. In this phenomenon, small fragments of plaque or clots break off and plug up blood vessels in the heart, which can damage the heart muscle. Patients who took cangrelor had a 73 percent lower chance of developing this dangerous complication than patients on ticagrelor.
After one year, cangrelor patients saw a much bigger increase in their heart's left ventricular ejection fraction (a measure of the heart's pumping ability) compared to patients on ticagrelor. Ultrasounds showed a showed a 37.9 percent improvement compared to ticagrelor's 21.7 percent, and MRIs showed a 15.8 percent increase for the cangrelor group compared to 2.1 percent on ticagrelor.
What this study means for patients and clinicians: Cardiogenic shock after a heart attack is fatal by a year in about half of patients. Use of potent blood thinners at the time of stenting may improve that grim prognosis and improve outcomes in cardiogenic shock. This is an important finding considering that no therapies other than prompt revascularization of the blocked vessel or mechanical heart pumps have ever been shown to be effective for cardiogenic shock.
What's next: Long-term follow-up of DAPT-SHOCK-AMI is ongoing, and should help teach researchers about the long-term prognosis of patients with acute myocardial infarction who develop cardiogenic shock and survive the initial event. Conducting larger, randomized trials on this subject may help further advance treatment, however, conducting these could be difficult, as these patients are the sickest of the sick.
Quotes: "This is the largest randomized trial of antiplatelet strategies in cardiogenic shock to date. Our findings should help inform the design of future trials in this difficult-to-study population," says Dr. Bhatt. "Beyond the findings regarding cangrelor, this trial establishes the value of serial echocardiography and MRI in characterizing recovery from cardiogenic shock, one of the most lethal conditions in medicine. Future studies can use the approaches we studied here to evaluate novel therapies for cardiogenic shock."
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