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. 2022 Oct 21;18(9):740-748.
doi: 10.4244/EIJ-D-22-00336.

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)

Martin Rauber  1   2   3 , Philipp Nicol  4 , Emina Sabic  4 , Michael Joner  4 , Marko Noc  1   3
Affiliations

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)

Martin Rauber et al. EuroIntervention. .

Abstract

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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Conflict of interest statement

Theauthors have no conflicts of interest to declare in relation to this study.

Figures

Central illustration
Central illustration. Study flowchart.
CAG: coronary angiography; OHCA: out-of-hospital cardiac arrest; PCI: percutaneous coronary intervention; POBA: plain old balloon angioplasty; ST: stent thrombosis
Figure 1
Figure 1. Detailed histological analysis of definite ST, post mortem thrombus and non-occlusive definite ST.
H&E staining, A1/B1/C1: 2x magnification, A2/B2/C2: 20x magnification of boxed area. (*)=stent struts. A1/A2) Definite acute occlusive stent thrombosis. Higher magnification (A2) reveals platelet-rich thrombotic material (black arrow) and fibrin-rich appositional thrombus (white arrow) with interspersed deposits of inflammatory cells (blue arrow), occluding approximately 75% of the lumen. B1/B2) Definite non-occlusive stent thrombosis. Higher magnification (B2) reveals non-occlusive stent thrombosis (black arrow) together with post mortem thrombus consisting mainly of erythrocytes (blue arrow). C1/C2) Post mortem thrombus. Higher magnification (C2) shows thrombus consisting mainly of erythrocytes (black arrow). H&E: haematoxylin & eosin; ST: stent thrombosis
Figure 2
Figure 2. Timing of definite ST.
CAG: coronary angiography; OHCA: out-of-hospital cardiac arrest; ST: stent thrombosis
See this image and copyright information in PMC

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