Abstract 18726: Definite Stent Thrombosis in Comatose Survivors of Out-of-Hospital Cardiac Arrest Undergoing Immediate Percutaneous Coronary Intervention and Hypothermia

Introduction: There is paucity of data about the incidence of stent thrombosis (ST) in comatose survivors of out-of-hospital cardiac arrest (OHCA) treated with immediate percutaneous coronary intervention (PCI) and mild induced hypothermia (MIH). Methods: We pooled consecutive patients with resuscitated OHCA undergoing immediate PCI and MIH (32 - 34 oC for 24 hours) enrolled in our studies on P2Y12 inhibitors performed between 2011 and 2016. At the time of PCI, all patients received intravenous acetylsalicylic acid (250 - 500 mg) and heparin (targeted to ACT 250 - 300). GP llb/llla was used on the discretion of the operator. Immediately after PCI, one of the P2Y12 inhibitors (clopidogrel, ticagrelor, prasugrel) was administered in loading dose via nasogastric tube as crushed and dissolved tablets. This was followed by daily acetylsalicylic acid (100 mg) and P2Y12 inhibitor in recommended maintenance dose. If ST was suspected (new ischemic ECG changes, unexpected rise in troponin, sudden hemodynamic worsening, malignant arrhythmias), immediate coronary angiography was performed. Results: A total of 138 patients were enrolled. On top of acetylsalicylic acid and heparin, clopidogrel was used 103 patients (75 %), ticagrelor in 27 (20 %) ticagrelor and prasugrel in 8 (6 %). Concomitant eptifibatide was administered in 20 patients (14 %). Coronary angiography which was performed if ST was suspected, revealed definite ST in 7 patients (5.1 %). Among them, 5 patients were on clopidogrel (4.9 %) and 2 patients on ticagrelor (7.4 %). ST occurred between day 0-7 (1.6 ± 2.5 days). Only 1 patient with ST (14 %) survived to hospital discharge. Conclusions: Despite recommended anticoagulation and antiplatelet management in comatose survivors of OHCA, definite ST is significantly increased and associated with worse clinical outcome. True definite ST might be even higher because autopsy was not routinely performed in patients who died.