Abstract Body (Do not enter title and authors here): Background
Intra-procedural cardiac arrest (IPCA) during percutaneous coronary intervention (PCI) is a rare but life-threatening complication. This study aims to compare outcomes in patients experiencing IPCA during PCI versus those undergoing PCI without cardiac
arrest.

Methods
We conducted a retrospective cohort analysis using the TriNetX global federated health research network, incorporating data from 103 healthcare organizations (2015-2025). Two cohorts were identified: Cohort 1 (PCI with IPCA; n = 3,619) and Cohort 2 (PCI without IPCA; n = 238,091). Propensity score matching (PSM) was applied to balance baseline characteristics (n = 3,861 per cohort). Outcomes were analyzed over a 30-day follow-up period and included in-hospital mortality, myocardial infarction (MI) and heart failure (HF), stroke/transient ischemic attack (TIA), and neurological complications(Anoxic brain damage, intraoperative or postprocedural nervous system complications, or mild cognitive impairment of uncertain etiology.

Results
Patients experiencing IPCA had significantly higher 30-day mortality (24.0% vs. 1.8%; p < 0.001; OR = 17.57, 95% CI: 13.67–22.59). They were at increased risk for MI/HF (17.5% vs. 6.6%; p < 0.001; OR = 2.98, 95% CI: 2.56–3.47), stroke/TIA (4.7% vs. 1.5%; p < 0.001; OR = 3.26, 95% CI: 2.42–4.40), and neurological complications (8.6% vs. 0.3%; p < 0.001; OR = 36.11, 95% CI: 19.22–67.85). Kaplan-Meier survival analysis showed significantly reduced survival probability in the IPCA group (p< 0.001).

Conclusion
IPCA during PCI is associated with markedly increased short-term mortality and adverse cardiovascular and neurological outcomes. These findings highlight the need for early recognition, prompt resuscitative measures, and post-arrest care strategies to improve survival and neurological recovery in this high-risk population.