Funding Acknowledgements Type of funding sources: None. Introduction Acute Myocardial Infarction (AMI) complicated by out-of-hospital cardiac arrest (OCHA) carries a poor prognosis. Emergent angiography and primary percutaneous coronary intervention (PPCI) has been shown to improve survival, however some patients are left with significant neurological sequelae. Targeted Temperature Management (TTM) in randomised controlled trials has improved neurological status in survivors, however concerns have arisen from case series demonstrating a higher incidence of stent thrombosis. Reduced absorption of orally-administered P2Y12 inhibitor medication has been demonstrated in this cohort on the intensive care unit (ICU) and has been proposed to account for an observed increase in stent thrombosis. Purpose Our aim was to assess the relationship between stent thrombosis and TTM in patients with OHCA due to AMI and undergoing primary percutaneous coronary intervention (PPCI). Methods We conducted a single centre, retrospective analysis of consecutive patients admitted to the East and North Hertfordshire NHS Trust with an OHCA secondary to ST-elevation myocardial infarction and treated with PPCI. All patients received aspirin loading and either enteral P2Y12 inhibitor loading (ticagrelor or clopidogrel) or intravenous (cangrelor) prior to or immediately after PPCI, according to clinician preference. Glycoprotein IIb/IIIa administration was determined by physician choice and documented. All patients were transferred to the ICU straight after PPCI, where some received TTM. Notes were reviewed to allow recording of demographic and procedural data, including post resuscitation care up to hospital discharge. Results A total of 92 patients were identified, 80% male and aged 62 +/-12.5 years. In addition to aspirin, patients were treated with P2Y12 inhibitors with 72.5% loaded with ticagrelor, 2.5% with clopidogrel and the remaining 25% with intravenous cangrelor. In addition, 49% of patients received periprocedural glycoprotein IIb/IIIa inhibitor. TTM was initiated in 38 patients (41%) using surface pads. The average duration of TTM was 24 hours. No cases of stent thrombosis occurred. In-hospital all-cause mortality was 24%. The death rate was higher amongst those patients who were cooled, but this difference was not statistically significant (35% vs 17%, p = 0.08). Cangrelor use was significantly higher in the cooled cohort (43% vs. 8%, p < 0.001), but glycoprotein IIb/IIIa inhibitor use was similar between those receiving and not receiving TTM (38% vs. 57%, p = 0.088). Conclusion No definite stent thromboses were recorded in the 92 patients reviewed, suggesting that TTM does not increase the risk of stent thrombosis. Our conclusion is limited by the small sample size, and the heterogeneity in P2Y12 inhibitor use, particularly the higher use of cangrelor in the cooled cohort.