Timing and predictors of definite stent thrombosis in comatose survivors of out-of-hospital cardiac arrest undergoing percutaneous coronary intervention and therapeutic hypothermia (ST-OHCA study)

DOI: 10.4244/EIJ-D-22-00336

Martin Rauber
Martin Rauber1,2,3; Philipp Nicol4; Emina Sabic4; Michael Joner4; Marko Noc1,3
1. Centre for Intensive Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia; 2. Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia; 3. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; 4. Deutsches Herzzentrum München, Munich, Germany

Background: Incidence of stent thrombosis (ST) in comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing immediate percutaneous coronary intervention (PCI) and therapeutic hypothermia (TH) varies considerably, from 2.7% to 31.2%, in retrospective studies.

Aims: We aimed to investigate occurrence, timing and predictors of definite ST.

Methods: We prospectively investigated consecutive comatose survivors of OHCA with presumed cardiac aetiology undergoing immediate PCI with drug-eluting stents (DES) and TH targeted at 32-34°C admitted between August 2016 and July 2021. Repeat coronary angiography (CAG) was performed if ST was suspected and systematically between day 8-12 in the absence of clinical signs. All deceased patients underwent autopsy and histopathological analysis. 

Results: Among 362 comatose survivors of OHCA, immediate PCI with stenting was performed in 169 patients (47%). Since 18 patients did not complete follow-up, 151 patients were ultimately enrolled in ST analysis. Definite ST was confirmed in 29 patients (19.2%; 95% confidence interval [CI]: 12.9%-25.6%) either by CAG (n=18) or autopsy (n=11). ST occurred within 3 days in 62% and presented with at least one clinical sign in 79%. Survival with good neurological recovery was observed in 17% of patients with ST and in 60% of patients without ST (p<0.001). Independent predictors of ST were longer prehospital resuscitation, lower arterial pH and increased creatinine on admission.

Conclusions: The incidence of definite ST in comatose survivors of OHCA undergoing immediate PCI and TH targeted at 32-34°C is substantial (19.2%) and significantly higher than in other PCI subsets despite systematic use of contemporary DES and anticoagulation/antiplatelet treatment. 

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drug-eluting stentout-of-hospital cardiac arreststent thrombosis
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