Cash, Michael, MD

Hsu, Paul, MD

Kern, Karl B, MD

McPherson, John, MD

Mooney, Michael R, MD

Nair, Sanjeev U, MD

Patel, Nainesh, MD

Seder, David B, MD

Unger, Barbara, RN

Young, Michael, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Risk of Stent Thrombosis in Cardiac Arrest Patients with ST- Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention and Therapeutic Hypothermia: International Cardiac Arrest Registry Nainesh Patel MD Lehigh Valley Health Network, nainesh_c.patel@lvhn.org Sanjeev U. Nair MD Lehigh Valley Health Network, sanjeev.nair@lvhn.org Michael R. Mooney MD John McPherson MD David B. Seder MD See next page for additional authors Follow this and additional works at: https://scholarlyworks.lvhn.org/medicine  Part of the Cardiology Commons, and the Medical Sciences Commons Published In/Presented At Patel, N., Nair, S., Mooney. M., McPherson, J., Seder, D., Hsu, P., Cash, M., Young, M., Unger, B., Kern, K. Risk of Stent Thrombosis in Cardiac Arrest Patients with ST- Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention and Therapeutic Hypothermia: International Cardiac Arrest Registry. Poster presented at: ACC 2015 Scientific Meeting, San Diego, CA. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Authors Nainesh Patel MD, Sanjeev U. Nair MD, Michael R. Mooney MD, John McPherson MD, David B. Seder MD, Paul Hsu MD, Michael Cash MD, Michael Young MD, Barbara Unger RN, and Karl B. Kern MD This poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/medicine/802 The International Cardiac Arrest Registry (INTCAR) – CARDIOLOGY Research Group**Lehigh Valley Health Network, Minneapolis Heart Institute, Vanderbilt University, Maine Medical Center, Ochsner Medical Center, and the University of ArizonaRisk of Stent Thrombosis in Cardiac Arrest Patients with ST- Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention and Therapeutic Hypothermia: International Cardiac Arrest RegistryNainesh C. Patel, MD; Sanjeev U. Nair, MD; Michael Mooney, MD; John McPherson, MD; David B Seder, MD; Paul Hsu, PhD; Michael Cash, MD; Michael Young, MD; Barbara Unger, RN;  Karl B Kern, MD© 2015 Lehigh Valley Health NetworkFlow DiagramROSC = return of spontaneous circulation; CPC = cerebral performance categoryTable 2. Patients Who Had Stent Thrombosis After PCI With TH   Patient 1 Patient 2Age (years) 45 79Sex Male FemaleSmoker No NoCongestive heart failure No YesChronic renal failure No NoDiabetes mellitus No NoEjection fraction Moderately depressed Moderately depressedCardiac arrest site Out-of-hospital Out-of-hospitalWitnessed arrest No YesInitial rhythm VF VFEstimated time of arrest until first defibrillation (minutes) 11 1Estimatd time to ROSC (minutes) 15 1Estimated time of arrest to CPR 11 minutes 1 minuteUse of active compression device No NoShock at admission No YesTime to cardiac catheterization >120 minutes 60 minutesPercutaneous coronary intervention Yes YesInfarct related artery LAD Right coronary arteryThrombectomy Yes YesNumber of stents 2 2Type of stent Drug eluting stent Drug eluting stentAntiplatelet drugs used clopidogrel clopidogrelIntra aortic balloon pump use No YesWas life support withdrawn No Not applicableCPC at hospital discharge 5 1   BackgroundTotal patients with out-of-hospital cardiac arrestundergoing TH(n=754)Patients presenting asSTEMI(n=198)Patients undergoing PCIwith stent(n=141)Patients with ST(n=2)Patients without ST(n=139)•		Percutaneous	coronary	intervention	(PCI)	in	out-of-hospital	cardiac	arrest	(OHCA)	patients	presenting	with	ST-elevation	myocardial	infarction	(STEMI)	and	who	undergo	therapeutic	hypothermia	(TH)	may	improve	outcomes.		•		However	the	risk	of	stent	thrombosis	in	such	patients	is	presently	unclear. Conclusions•		The	risk	of	definite	stent	thrombosis	prior	to	discharge	from	hospital	in	cardiac	arrest	patients	with	STEMI	undergoing	combined	PCI	and	TH	is	very	small.	•		Therapeutic	Hypothermia	in	OHCA	undergoing	PCI	does	not	increase	the	risk	of	definite	stent	thrombosis	before	hospital	discharge.Results (continued)Objective•		To	evaluate	the	risk	of	definite	stent	thrombosis	prior	to	hospital	discharge	in	OHCA	patients	with	STEMI	undergoing	combined	PCI	and	TH.Methods•		We	analyzed	the	International	Cardiac	Arrest	Registry	1.0,	a	large	multicenter	database.•		The	database	consists	of	754	consecutive	patients	who	presented	after	resuscitation	from	OHCA	and	underwent	TH	between	2006	and	2011.*INTCAR is generously supported by grants from the Stig and Ragna Gorthon Foundation, Scandinavian Society of Anaesthesiology and Intensive Care, Lund University, and Maine Medical Center.Results•		Of	the	198	patients	who	had	cardiac	arrest	with	STEMI,	141	patients	(71%)	underwent	combined	PCI	and	TH.•		Two	patients	(1.4%)	developed	definite	stent	thrombosis	prior	to	discharge	from	hospital	(flow	diagram)Table 1. Demographics/Clinical  Characteristics of Study CohortVariables   Mean +/- SD/ N(%)Age (years) 60.60+/-11.70Male 112 (79.43)Congestive heart failure 11 (7.80)Chronic renal failure 4 (2.84)Diabetes mellitus 19 (13.48)Ejection fraction in % (N=117)       1: normal 27 (23.08)      2: moderate 49 (41.88)      3: Severe 41 (35.04)Witnessed arrest (yes) (N=140) 123 (87.86)Initial rhythm       Pulseless electrical activity 14 (9.93)      Ventricular tachycardia/VF 121 (85.82)      Asystole 6 (4.26)Estimated time from ROSC (N=134) 24.19+/-15.22 minutesShock at admission (yes) (N=140) 61 (43.57)Intra-aortic balloon pump use 49 (34.75)Anti-platelet drug used 141 (100.00)Life support withdraw (yes) 51 (36.17)Hospital D/C CPC       CPC1 52 (36.88)      CPC2 20 (14.18)      CPC3 9 (6.38)      CPC4 2 (1.42)      CPC5 58 (41.13)  VF = ventricular fibrillation; ROSC = return of spontaneous circulation; CPC = cerebral performance category 

Risk of Stent Thrombosis in Cardiac Arrest Patients with ST- Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention and Therapeutic Hypothermia: International Cardiac Arrest Registry

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1816&context=medicine

Risk of Stent Thrombosis in Cardiac Arrest Patients with ST- Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention and Therapeutic Hypothermia: International Cardiac Arrest Registry

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