Background: Myocardial Infarction (MI) is the leading cause of Out-of-Hospital Cardiac Arrest (OHCA). The management of periprocedural antithrombotic therapy in this setting is still challenging due to limited data available and given the heightened thrombotic and hemorrhagic risks in this subset of patients. We aimed to investigate the application of antithrombotic therapy, in-hospital bleeding rate and mortality in OHCA patients undergoing percutaneous coronary intervention (PCI).
Methods: a multicentric, prospective, observational study was conducted, enrolling all consecutive OHCA patients from January 1st, 2015, to December 31st, 2022, undergoing PCI at 6 Northern Italy centers. Bleeding events were categorized using the BARC (Bleeding Academic Research Consortium) scale, defining major bleeding as BARC ≥ 3.
Results: a total of 623 patients were included; of these, 403 underwent coronary angiography and 249 underwent PCI. Patients’ median age was 64.0 years (54-73); femoral artery was the site of access for PCI in 131 (52.6%) patients. Ticagrelor was the most used oral P2Y12 inhibitor, with 164 patients (65.9%) receiving it, while cangrelor and a glycoprotein (GP) IIb/IIIa receptor inhibitor were used in 27 (10.8%) and 66 (25.3%) patients, respectively. Overall survival rate at hospital discharge was 69.5%. Minor and major bleeding events occurred during hospital stay in 12 (4.8%) and 19 (7.6%) patients, respectively. While the rate of major bleeding was similar among patient groups treated with different oral P2Y12 inhibitors, patients treated with cangrelor or GPIIb/IIIa inhibitors exhibited a higher prevalence of major bleeding events (cangrelor: 7/27 vs 12/219, χ² = 5.4248, p = 0.006; GPIIb/IIIa inhibitors: 9/63 vs 10/183, χ² = 14.0994, p = 0.002). Regardless of baseline bleeding risk, cangrelor was significantly associated with the risk of a bleeding event [OR 6.8 (CI 2.3 to 20.4); p-value < 0.001] and with an increase probability of survival at discharge [OR 3.7 (CI 1.2 to 12.8); p-value 0.037]. Conclusions: in patients with OHCA undergoing PCI, administration of cangrelor was associated with an increased risk of in-hospital bleeding events and, at the same time, with a better survival at discharge. Our results suggest a potential net clinical benefit that may outweigh the increased bleeding risk, possibly due to its protective effect against periprocedural thrombotic events. Specific and larger studies are needed to confirm this hypothesis.