<h2 id="hl0001122">Abstract</h2> <h2 id="hl0001124">Aim</h2> <p id="hl0001125">To determine long-term survival of patients after cardiac arrest undergoing emergent coronary angiography and therapeutic hypothermia.</p> <h2 id="hl0001127">Methods</h2> <p id="hl0001128">We analysed data from patients treated within the regional STEMI Network from January 2015 to December 2020. The primary endpoint was all-cause mortality at median follow-up. Secondary endpoints were periprocedural complications (arrhythmias, pulmonary edema, cardiogenic shock, mechanical complication, stent thrombosis, reinfarction, bleeding) and 6-month all-cause death. A landmark analysis was performed, studying two time periods; 0–6 months and beyond 6 months.</p> <h2 id="hl0001130">Results</h2> <p id="hl0001131">From a total of 24,125 patients in the regional STEMI network, 494 patients who suffered from cardiac arrest were included and divided into two groups: treated with (<span> </span><i>n</i><span> </span>= 119) and without therapeutic hypothermia (<span> </span><i>n</i><span> </span>= 375). At median follow−up (16.0 [0.2–33.3] months), there was no difference in the adjusted mortality rate between groups (51.3 % with hypothermia vs 48.0 % without hypothermia; HR<span> </span><sub>adj</sub><span> </span>1.08 95%CI [0.77–1.53];<span> </span><i>p</i><span> </span>= 0.659). There was a higher frequency of bleeding in the hypothermia group (6.7 % vs 1.1 %; OR<span> </span><sub>adj</sub><span> </span>7.99 95%CI [2.05–31.2];<span> </span><i>p</i><span> </span>= 0.002), without difference for the rest of periprocedural complications. At 6-month follow−up, adjusted all-cause mortality rate was similar between groups (46.2 % with hypothermia vs 44.5 % without hypothermia; HR<span> </span><sub>adj</sub><span> </span>1.02 95%CI [0.71–1.47];<span> </span><i>p</i><span> </span>= 0.900). Also, no differences were observed in the adjusted mortality rate between 6 months and median follow−up (9.4 % with hypothermia vs 6.3 % without hypothermia; HR<span> </span><sub>adj</sub><span> </span>2.02 95%CI [0.69–5.92];<span> </span><i>p</i><span> </span>= 0.200).</p> <h2 id="hl0001143">Conclusions</h2> <p id="hl0001144">In a large cohort of patients with cardiac arrest within a regional STEMI network, those treated with therapeutic hypothermia did not improve long−term survival compared to those without hypothermia.</p>