title: Stent thrombosis after primary percutaneous coronary intervention in comatose survivors of out-of-hospital cardiac arrest: Are the new P2Y12 inhibitors really more effective than clopidogrel?
abstract: OBJECTIVE
  High rates of stent thrombosis (ST) have been reported in patients with out-of-hospital cardiac arrest (OHCA) who require a primary percutaneous coronary intervention (PCI). The aim of this study was to assess risk factors of ST in this population with a special focus on antiplatelet therapy administered during the acute phase.
  
  
  METHODS
  We conducted a retrospective observational study in patients treated with primary PCI after OHCA between 2011 and 2013 in our center. All consecutive patients were treated with mild therapeutic hypothermia and dual antiplatelet therapy after primary angioplasty.
  
  
  RESULTS
  A total of 101 consecutive patients were included in the present analysis. Mean age was 61.3 ± 12.7 years and 75% of patients had an initial ventricular fibrillation. All patients received aspirin before PCI. P2Y12 inhibitors were administered after PCI and included clopidogrel (47.5%), prasugrel (21.8%) or ticagrelor (29.7%). The survival rate at discharge was 44.5%. We identified 11 cases (10.9%) of definite or probable ST (clopidogrel (n=2), prasugrel (n=4) and ticagrelor (n=5)) occurring at a median of 2 days after PCI. No specific predictors were found to be significantly associated with ST. New P2Y12 inhibitors were associated with more ST compared to clopidogrel (17.3% vs. 4.2%; respectively, p=0.05). ST was associated with a decreased left ventricular ejection fraction (p=0.007) and with a trend toward a higher mortality compared to patients without ST (82% vs. 52%, p=0.06).
  
  
  CONCLUSIONS
  The incidence of ST in OHCA survivors is high and associated with poor clinical outcome. The use of new oral P2Y12 inhibitors does not appear to be associated with a reduction in ST compared to clopidogrel.
authors.affiliation: AP-HP Hôpital Cochin, Service de Cardiologie, Paris 75014, France; Université Paris Descartes, Faculté de Médecine, Paris 75014, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gouffran
authors.affiliation: AP-HP Hôpital Cochin, Service de Cardiologie, Paris 75014, France; Université Paris Descartes, Faculté de Médecine, Paris 75014, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Rosencher
authors.affiliation: Université Paris Descartes, Faculté de Médecine, Paris 75014, France; AP-HP Hôpital Cochin, Service de Réanimation Médicale, Paris 75014, France; INSERM U970, Centre d'Expertise de la Mort Subite (CEMS), Paris 75015, France.
authors.forename: Wulfran
authors.initials: W
authors.lastname: Bougouin
authors.affiliation: AP-HP Hôpital Cochin, Service de Cardiologie, Paris 75014, France; Université Paris Descartes, Faculté de Médecine, Paris 75014, France.
authors.forename: Reda
authors.initials: R
authors.lastname: Jakamy
authors.affiliation: Université Paris Descartes, Faculté de Médecine, Paris 75014, France; AP-HP Hôpital Cochin, Service de Réanimation Médicale, Paris 75014, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Joffre
authors.affiliation: Université Paris Descartes, Faculté de Médecine, Paris 75014, France; AP-HP Hôpital Cochin, Service d'Admission des Urgences, Paris 75014, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.affiliation: Université Paris Descartes, Faculté de Médecine, Paris 75014, France; INSERM U970, Centre d'Expertise de la Mort Subite (CEMS), Paris 75015, France; AP-HP Hôpital Necker, SAMU 75, Paris 75015, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.affiliation: Université Paris Descartes, Faculté de Médecine, Paris 75014, France; AP-HP Hôpital Cochin, Service de Réanimation Médicale, Paris 75014, France; INSERM U970, Centre d'Expertise de la Mort Subite (CEMS), Paris 75015, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.affiliation: AP-HP Hôpital Cochin, Service de Cardiologie, Paris 75014, France; Université Paris Descartes, Faculté de Médecine, Paris 75014, France; INSERM U970, Centre d'Expertise de la Mort Subite (CEMS), Paris 75015, France. Electronic address: olivier.varenne@cch.aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
mesh_terms: D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D003128:Coma; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
keywords: Out-of-hospital cardiac arrest; Percutaneous coronary intervention; Stent thrombosis