A Pilot Study of Rapid Cooling by Cold Saline and Endovascular Cooling Before Reperfusion in Patients With ST-Elevation Myocardial Infarction
Open Access
- 1 October 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Interventions
- Vol. 3 (5), 400-407
- https://doi.org/10.1161/circinterventions.110.957902
Abstract
Background—: Experimental studies have shown that induction of hypothermia before reperfusion of acute coronary occlusion reduces infarct size. Previous clinical studies, however, have not been able to show this effect, which is believed to be mainly because therapeutic temperature was not reached before reperfusion in the majority of the patients. We aimed to evaluate the safety and feasibility of rapidly induced hypothermia by infusion of cold saline and endovascular cooling catheter before reperfusion in patients with acute myocardial infarction. Methods and Results—: Twenty patients with acute myocardial infarction scheduled to undergo primary percutaneous coronary intervention were enrolled in this prospective, randomized study. After 4±2 days, myocardium at risk and infarct size were assessed by cardiac magnetic resonance using T2-weighted imaging and late gadolinium enhancement imaging, respectively. A core body temperature of P =0.12). Despite similar duration of ischemia (174±51 minutes versus 174±62 minutes, hypothermia versus control, P =1.00), infarct size normalized to myocardium at risk was reduced by 38% in the hypothermia group compared with the control group (29.8±12.6% versus 48.0±21.6%, P =0.041). This was supported by a significant decrease in both peak and cumulative release of Troponin T in the hypothermia group ( P =0.01 and P =0.03, respectively). Conclusions—: The protocol demonstrates the ability to reach a core body temperature of <35°C before reperfusion in all patients without delaying primary percutaneous coronary intervention and that combination hypothermia as an adjunct therapy in acute myocardial infarction may reduce infarct size at 3 days as measured by MRI. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00417638.Keywords
This publication has 17 references indexed in Scilit:
- Design and validation of Segment - freely available software for cardiovascular image analysisBMC Medical Imaging, 2010
- Myocardium at Risk After Acute Infarction in Humans on Cardiac Magnetic Resonance: Quantitative Assessment During Follow-Up and Validation With Single-Photon Emission Computed TomographyJACC: Cardiovascular Imaging, 2009
- Rapid Initial Reduction of Hyperenhanced Myocardium After Reperfused First Myocardial Infarction Suggests Recovery of the Peri-Infarction ZoneCirculation: Cardiovascular Imaging, 2009
- Rapid short-duration hypothermia with cold saline and endovascular cooling before reperfusion reduces microvascular obstruction and myocardial infarct sizeBMC Cardiovascular Disorders, 2008
- Hypothermia during reperfusion does not reduce myocardial infarct size in pigsBasic Research in Cardiology, 2005
- Feasibility of endovascular cooling as an adjunct to primary percutaneous coronary intervention (results of the LOWTEMP pilot study)The American Journal of Cardiology, 2004
- Regional hypothermia reduces myocardial necrosis even when instituted after the onset of ischemiaBasic Research in Cardiology, 1997
- Does reperfusion injury exist in humans?Journal of the American College of Cardiology, 1993
- The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs.Circulation, 1977
- The “No-Reflow” Phenomenon after Temporary Coronary Occlusion in the DogJCI Insight, 1974