title: Safety of therapeutic hypothermia combined with primary percutaneous coronary intervention after out-of-hospital cardiac arrest.
abstract: BACKGROUND
  The safety of therapeutic hypothermia combined with percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest has been challenged after reports of high risk of stent thrombosis.
  
  
  METHODS
  We searched the Western Denmark Heart Registry to identify patients with an acute coronary angiography due to out-of-hospital cardiac arrest performed at our institution between September 2010 and September 2013. We identified 68 unconscious patients, who were resuscitated after out-of-hospital cardiac arrest and underwent acute PCI with stent implantation and immediate therapeutic hypothermia, and followed these for 30 days. Target temperature of 32-34°C was achieved by either an invasive or a non-invasive cooling system.
  
  
  RESULTS
  All patients had elevated myocardial biomarkers and 37 patients had ST-segment elevation myocardial infarction. Bare metal stents were implanted in 14 and drug-eluting stents in 54 patients. All patients received antithrombotic treatment with a standard loading dose of 300 mg acetylsalicylic acid and 10,000 units heparin intravenously prior PCI. Clopidogrel or ticagrelor was administered orally through a gastric tube immediately after PCI. During the procedure abciximab or bivalirudin was administered in 44 patients. Electrocardiographic and clinical signs of stent thrombosis were found in one patient.
  
  
  CONCLUSIONS
  We observed one stent thrombosis in this cohort of 68 consecutive patients with out-of-hospital cardiac arrest who were treated with PCI and therapeutic hypothermia. This suggests that PCI with stent implantation can be performed with acceptable safety in these patients.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark grochi@rm.dk.
authors.forename: Gro E
authors.initials: GE
authors.lastname: Chisholm
authors.affiliation: Research Center for Emergency Medicine, Aarhus University Hospital, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Grejs
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Troels
authors.initials: T
authors.lastname: Thim
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Evald H
authors.initials: EH
authors.lastname: Christiansen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Kaltoft
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Jens F
authors.initials: JF
authors.lastname: Lassen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Steen D
authors.initials: SD
authors.lastname: Kristensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Maeng
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D003131:Combined Modality Therapy; D017023:Coronary Angiography / Q000379:methods; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D061214:Patient Safety; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents
keywords: Antithrombotic treatment; ischemic heart disease; out-of-hospital cardiac arrest; percutaneous coronary intervention; safety; stent thrombosis; therapeutic hypothermia