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Effects of endovascular cooling on infarct size in ST-segment elevation myocardial infarction : A patient-level pooled analysis from randomized trials

Dae, Michael ; O'Neill, William ; Grines, Cindy ; Dixon, Simon ; Erlinge, David LU ; Noc, Marko ; Holzer, Michael and Dee, Anne (2018) In Journal of Interventional Cardiology 31(3). p.269-276
Abstract

Objectives: This study sought to examine the relationship between temperature at reperfusion and infarct size. Background: Hypothermia consistently reduces infarct size when administered prior to reperfusion in animal studies, however, clinical results have been inconsistent. Methods: We performed a patient-level pooled analysis from six randomized control trials of endovascular cooling during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in 629 patients in which infarct size was assessed within 1 month after randomization by either single-photon emission computed tomography (SPECT) or cardiac magnetic resonance imaging (cMR). Results: In anterior infarct patients, after... (More)

Objectives: This study sought to examine the relationship between temperature at reperfusion and infarct size. Background: Hypothermia consistently reduces infarct size when administered prior to reperfusion in animal studies, however, clinical results have been inconsistent. Methods: We performed a patient-level pooled analysis from six randomized control trials of endovascular cooling during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in 629 patients in which infarct size was assessed within 1 month after randomization by either single-photon emission computed tomography (SPECT) or cardiac magnetic resonance imaging (cMR). Results: In anterior infarct patients, after controlling for variability between studies, mean infarct size in controls was 21.3 (95%CI 17.4-25.3) and in patients with hypothermia <35°C it was 14.8 (95%CI 10.1-19.6), which was a statistically significant absolute reduction of 6.5%, or a 30% relative reduction in infarct size (P = 0.03). There was no significant difference in infarct size in anterior ≥35°C, or inferior infarct patients. There was no difference in the incidence of death, ventricular arrhythmias, or re-infarction due to stent thrombosis between hypothermia and control patients. Conclusions: The present study, drawn from a patient-level pooled analysis of six randomized trials of endovascular cooling during primary PCI in STEMI, showed a significant reduction in infarct size in patients with anterior STEMI who were cooled to <35°C at the time of reperfusion. The results support the need for trials in patients with anterior STEMI using more powerful cooling devices to optimize the delivery of hypothermia prior to reperfusion.

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Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hypothermia, infarct size, STEMI
in
Journal of Interventional Cardiology
volume
31
issue
3
pages
8 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:29243292
  • scopus:85038025965
ISSN
0896-4327
DOI
10.1111/joic.12485
language
English
LU publication?
yes
id
38b94cf3-c576-4c3a-8f1d-331111921009
date added to LUP
2019-05-23 10:52:26
date last changed
2020-01-16 03:56:28
@article{38b94cf3-c576-4c3a-8f1d-331111921009,
  abstract     = {<p>Objectives: This study sought to examine the relationship between temperature at reperfusion and infarct size. Background: Hypothermia consistently reduces infarct size when administered prior to reperfusion in animal studies, however, clinical results have been inconsistent. Methods: We performed a patient-level pooled analysis from six randomized control trials of endovascular cooling during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in 629 patients in which infarct size was assessed within 1 month after randomization by either single-photon emission computed tomography (SPECT) or cardiac magnetic resonance imaging (cMR). Results: In anterior infarct patients, after controlling for variability between studies, mean infarct size in controls was 21.3 (95%CI 17.4-25.3) and in patients with hypothermia &lt;35°C it was 14.8 (95%CI 10.1-19.6), which was a statistically significant absolute reduction of 6.5%, or a 30% relative reduction in infarct size (P = 0.03). There was no significant difference in infarct size in anterior ≥35°C, or inferior infarct patients. There was no difference in the incidence of death, ventricular arrhythmias, or re-infarction due to stent thrombosis between hypothermia and control patients. Conclusions: The present study, drawn from a patient-level pooled analysis of six randomized trials of endovascular cooling during primary PCI in STEMI, showed a significant reduction in infarct size in patients with anterior STEMI who were cooled to &lt;35°C at the time of reperfusion. The results support the need for trials in patients with anterior STEMI using more powerful cooling devices to optimize the delivery of hypothermia prior to reperfusion.</p>},
  author       = {Dae, Michael and O'Neill, William and Grines, Cindy and Dixon, Simon and Erlinge, David and Noc, Marko and Holzer, Michael and Dee, Anne},
  issn         = {0896-4327},
  language     = {eng},
  month        = {06},
  number       = {3},
  pages        = {269--276},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Interventional Cardiology},
  title        = {Effects of endovascular cooling on infarct size in ST-segment elevation myocardial infarction : A patient-level pooled analysis from randomized trials},
  url          = {http://dx.doi.org/10.1111/joic.12485},
  doi          = {10.1111/joic.12485},
  volume       = {31},
  year         = {2018},
}