In this letter, we report our experience in patients with ACS and cardiac arrest treated with HT and its association with a high incidence of stent thrombosis (ST). From January 2010 through March 2012, a total of 28 comatose patients (20 men, mean age: 55 ± 18 years) were admitted to our hospital for out-of-hospital cardiac arrest and were treated with HT. In all cases, the first rhythm was ventricular fibrillation. HT was started in the emergency area by the administration of 4°C saline, 30 ml/kg (maximum: 2 l) infused in 30 min. Infusion was stopped if the temperature was < 33.5°C. In the intensive care unit, patients received standard treatment that included mechanical ventilation and correction of cardiovascular instability. All patients were sedated with an infusion of midazolam and morphine at doses that were adjusted for the management of mechanical ventilation. Neuromuscular relaxation was achieved with cisatracurium infusion to avoid muscular tremor. A urinary catheter with temperature sensor (Foley catheter, Rüsch sensor series 400 [silicon], Curity, Tyco, Athione, Ireland) was implanted. The extracorporeal HT system (Medivance Arctic Sun System, Louisville, Colorado) was used to control temperature. All patients reached 33°C fewer than 8 h from cardiac arrest, and this temperature was maintained for 24 h. Warming took place gradually in 24 to 30 h, with a rate of 0.10 to 0.15°C/h.