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Effect of intravascular cooling on microvascular obstruction (MVO) in conscious patients with ST-elevation myocardial infarction undergoing primary PCI : Results from the COOL AMI EU pilot study

Keeble, Thomas R.; Karamasis, Grigoris V.; Noc, Marco; Sredniawa, Beata; Aradi, Daniel; Neskovic, Aleksandar N.; Arheden, Håkan LU ; Erlinge, David LU and Holzer, Michael (2018) In Cardiovascular Revascularization Medicine
Abstract

Objective: COOL AMI EU pilot was a multi-center, randomized controlled trial to assess feasibility and safety of rapid intravascular therapeutic hypothermia (TH) in conscious patients with anterior ST-elevation myocardial infarction (STEMI) undergoing primary PCI (PPCI). We report the effect of hypothermia upon microvascular obstruction (MVO). Methods: Conscious patients with anterior STEMI and symptom duration <6 h were recruited and randomized to PPCI + TH or PPCI alone. TH was induced using the ZOLL® Proteus™ intravascular temperature management system and rapid infusion of 1 L of cold normal saline, with a target temperature of 32 °C. MVO was measured by cardiac magnetic resonance (CMR) at 4 to 6 days post-MI. MVO larger than... (More)

Objective: COOL AMI EU pilot was a multi-center, randomized controlled trial to assess feasibility and safety of rapid intravascular therapeutic hypothermia (TH) in conscious patients with anterior ST-elevation myocardial infarction (STEMI) undergoing primary PCI (PPCI). We report the effect of hypothermia upon microvascular obstruction (MVO). Methods: Conscious patients with anterior STEMI and symptom duration <6 h were recruited and randomized to PPCI + TH or PPCI alone. TH was induced using the ZOLL® Proteus™ intravascular temperature management system and rapid infusion of 1 L of cold normal saline, with a target temperature of 32 °C. MVO was measured by cardiac magnetic resonance (CMR) at 4 to 6 days post-MI. MVO larger than 3.9% of LV was considered as extensive MVO. Results: 50 patients were randomized; mean age was 58 years, and 86% were men. At reperfusion, mean intravascular temperature for the TH group was 33.6 ± 1 °C. The presence of MVO was high and not different in both groups (74% vs. 77%, p = 0.79). The proportion of patients with extensive MVO was 11% in the TH group and 23% in the control group (OR 0.4 95%CI 0.07–2.35, p = 0.30). Patients with extensive MVO showed reduced EF at 4–6 days (34% versus 43%, p = 0.01). The percentage of patients with EF <35% at 30 days was 6% in the TH group versus 24% in the control group (p = 0.19). Conclusion: In the COOL-AMI Pilot Trial, the presence of MVO in both test groups was high and extensive MVO was related with reduced LVEF. The efficacy of therapeutic hypothermia (TH) in MVO reduction should be tested in a pivotal trial.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Cardiac magnetic resonance, Hypothermia, Microvascular obstruction (MVO), PPCI, STEMI
in
Cardiovascular Revascularization Medicine
publisher
Elsevier Inc.
external identifiers
  • scopus:85056169302
ISSN
1553-8389
DOI
10.1016/j.carrev.2018.09.014
language
English
LU publication?
yes
id
e3fc062b-a5c4-4dcb-b9b9-a255b346328f
date added to LUP
2018-11-23 12:41:38
date last changed
2019-03-19 04:02:52
@article{e3fc062b-a5c4-4dcb-b9b9-a255b346328f,
  abstract     = {<p>Objective: COOL AMI EU pilot was a multi-center, randomized controlled trial to assess feasibility and safety of rapid intravascular therapeutic hypothermia (TH) in conscious patients with anterior ST-elevation myocardial infarction (STEMI) undergoing primary PCI (PPCI). We report the effect of hypothermia upon microvascular obstruction (MVO). Methods: Conscious patients with anterior STEMI and symptom duration &lt;6 h were recruited and randomized to PPCI + TH or PPCI alone. TH was induced using the ZOLL® Proteus™ intravascular temperature management system and rapid infusion of 1 L of cold normal saline, with a target temperature of 32 °C. MVO was measured by cardiac magnetic resonance (CMR) at 4 to 6 days post-MI. MVO larger than 3.9% of LV was considered as extensive MVO. Results: 50 patients were randomized; mean age was 58 years, and 86% were men. At reperfusion, mean intravascular temperature for the TH group was 33.6 ± 1 °C. The presence of MVO was high and not different in both groups (74% vs. 77%, p = 0.79). The proportion of patients with extensive MVO was 11% in the TH group and 23% in the control group (OR 0.4 95%CI 0.07–2.35, p = 0.30). Patients with extensive MVO showed reduced EF at 4–6 days (34% versus 43%, p = 0.01). The percentage of patients with EF &lt;35% at 30 days was 6% in the TH group versus 24% in the control group (p = 0.19). Conclusion: In the COOL-AMI Pilot Trial, the presence of MVO in both test groups was high and extensive MVO was related with reduced LVEF. The efficacy of therapeutic hypothermia (TH) in MVO reduction should be tested in a pivotal trial.</p>},
  author       = {Keeble, Thomas R. and Karamasis, Grigoris V. and Noc, Marco and Sredniawa, Beata and Aradi, Daniel and Neskovic, Aleksandar N. and Arheden, Håkan and Erlinge, David and Holzer, Michael},
  issn         = {1553-8389},
  keyword      = {Cardiac magnetic resonance,Hypothermia,Microvascular obstruction (MVO),PPCI,STEMI},
  language     = {eng},
  month        = {10},
  publisher    = {Elsevier Inc.},
  series       = {Cardiovascular Revascularization Medicine},
  title        = {Effect of intravascular cooling on microvascular obstruction (MVO) in conscious patients with ST-elevation myocardial infarction undergoing primary PCI : Results from the COOL AMI EU pilot study},
  url          = {http://dx.doi.org/10.1016/j.carrev.2018.09.014},
  year         = {2018},
}