Key result
OHCA in STEMI patients linked to ~3-fold greater stent thrombosis and increased major bleeding.
Why the study?
Data is scarce on hemorrhagic and thrombotic complications in STEMI patients associated with out-of-hospital cardiac arrest (OHCA).
Do STEMI patients with out-of-hospital cardiac arrest have higher rates of thrombosis and hemorrhage compared to STEMI patients without cardiac arrest?
Observational (n=695)
No
Do STEMI patients with out-of-hospital cardiac arrest have higher rates of thrombosis and hemorrhage compared to STEMI patients without cardiac arrest?
Absolute Event Rate: 7.5% vs 2.6%
p-value: p=0.004
STEMI patients presenting with out-of-hospital cardiac arrest have significantly higher rates of both early stent thrombosis and major bleeding following stent implantation compared to those without cardiac arrest.
STEMI-OHCA patients show higher stent thrombosis and bleeding rates; leaves open optimal antithrombotic strategies for prospective evaluation.
BACKGROUND: Data is scarce on hemorrhagic and thrombotic complications in patients with ST-elevation myocardial infarction (STEMI) associated with out-of-hospital cardiac arrest (OHCA). METHODS: This is a monocentric, retrospective study conducted from January 2012 to December 2017 in a tertiary university hospital, which serves as a cardiac arrest center for a large urban area. Over the study period, all consecutive patients who were treated with stent implantation for STEMI with or without OHCA were included. Baseline characteristics, treatments, hemorrhagic and thrombotic events were compared between STEMI patients with and without OHCA. Univariate and multivariate analysis were performed in order to identify predictors of 30-day mortality, occurrence of major bleeding (MB), and early stent thrombosis (ST). RESULTS: A total of 549 patients treated for STEMI without OHCA and 146 patients for STEMI with OHCA were included. The incidence of definite ST and MB after coronary angioplasty was significantly higher in patients with OHCA (2.6% vs. 7.5%, p = 0.004 and 3.3% vs. 19.2%, p < 0.001, respectively). Independent predictors of MB in OHCA patients were anticoagulation therapy (HR = 3.11, 95%CI [1.22-7.98], p = 0.02) and the use of glycoprotein IIb/IIIa inhibitors (HR = 4.16, 95%CI [1.61-10.79], p = 0.003). Independent predictors of mortality in OHCA patients were age (HR = 1.05, 95%CI [1.02-1.09], p = 0.004) and ST (HR = 5.62, 95%CI [1.61-19.65], p = 0.007, with a protective effect of new anti-P2Y12 treatments (HR = 0.20, 95%CI [0.08-0.46], p < 0.001). CONCLUSION: Patients treated for STEMI associated with OHCA are at higher-risk of ST and MB than those who did not experience cardiac arrest. In this subset of patients, prospective studies are needed to better evaluate the balance of thrombosis and hemorrhage.
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Picard et al. (2019) conducted an observational in ST-elevation myocardial infarction (STEMI) with or without out-of-hospital cardiac arrest (OHCA) (n=695). Out-of-hospital cardiac arrest (OHCA) vs. STEMI without OHCA was evaluated on Definite stent thrombosis (ST) (p=0.004). STEMI patients with out-of-hospital cardiac arrest had significantly higher rates of definite stent thrombosis (7.5% vs 2.6%, p=0.004) and major bleeding (19.2% vs 3.3%, p<0.001) than those without.
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