Guillaume Gouffran1, Julien Rosencher1, Wulfran Bougouin2, Reda Jakamy1, Jérémie Joffre3, Lionel Lamhaut4, Florence Dumas5, Alain Cariou2, Olivier Varenne6. 1. AP-HP Hôpital Cochin, Service de Cardiologie, Paris 75014, France; Université Paris Descartes, Faculté de Médecine, Paris 75014, France. 2. 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. 3. Université Paris Descartes, Faculté de Médecine, Paris 75014, France; AP-HP Hôpital Cochin, Service de Réanimation Médicale, Paris 75014, France. 4. Université Paris Descartes, Faculté de Médecine, Paris 75014, France; AP-HP Hôpital Cochin, Service d'Admission des Urgences, Paris 75014, France. 5. 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. 6. 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.
Abstract
AIM: 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. MATERIALS AND 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). CONCLUSION: 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.
AIM: 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. MATERIALS AND 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). CONCLUSION: 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: Julia M Umińska; Jakub Ratajczak; Katarzyna Buszko; Przemysław Sobczak; Wiktor Sroka; Michał P Marszałł; Piotr Adamski; Klemen Steblovnik; Marko Noč; Jacek Kubica Journal: Cardiol J Date: 2019-02-25 Impact factor: 2.737
Authors: Florian Prüller; Oliver Leopold Milke; Lukasz Bis; Friedrich Fruhwald; Daniel Scherr; Philipp Eller; Sascha Pätzold; Siegfried Altmanninger-Sock; Peter Rainer; Jolanta Siller-Matula; Dirk von Lewinski Journal: Ann Intensive Care Date: 2018-02-21 Impact factor: 6.925
Authors: Paul Marc Biever; Dawid Leander Staudacher; Jonas Degott; Corinna Nadine Lang; Christoph Bode; Tobias Wengenmayer Journal: Clin Res Cardiol Date: 2019-07-12 Impact factor: 5.460
Authors: Ayman Elbadawi; Islam Y Elgendy; Ahmed H Mohamed; Kirolos Barssoum; Erfan Alotaki; Gbolahan O Ogunbayo; Khaled M Ziada Journal: Cardiol Ther Date: 2018-09-04
Authors: Florian Prüller; Lukasz Bis; Oliver Leopold Milke; Friedrich Fruhwald; Sascha Pätzold; Siegfried Altmanninger-Sock; Jolanta Siller-Matula; Friederike von Lewinski; Klemens Ablasser; Michael Sacherer; Dirk von Lewinski Journal: J Clin Med Date: 2018-11-15 Impact factor: 4.241