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Clinical Research in Cardiology
Published in: Clinical Research in Cardiology 1/2021

01-01-2021 | Myocardial Infarction | Original Paper

Hypothermia in patients with acute myocardial infarction: a meta-analysis of randomized trials

Authors: Brunilda Alushi, Gjin Ndrepepa, Alexander Lauten, Anna Lena Lahmann, Dario Bongiovanni, Sebastian Kufner, Erion Xhepa, Karl-Ludwig Laugwitz, Michael Joner, Ulf Landmesser, Holger Thiele, Adnan Kastrati, Salvatore Cassese

Published in: Clinical Research in Cardiology | Issue 1/2021

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Abstract

Background

In patients with acute myocardial infarction (MI) receiving percutaneous coronary intervention (PCI), the role of systemic therapeutic hypothermia remains controversial. We sought to investigate the role of systemic therapeutic hypothermia versus standard of care in patients with acute MI treated with PCI.

Methods

This is a study-level meta-analysis of randomized trials. The primary outcome was all-cause death. The main secondary outcome was infarct size. Other secondary outcomes were recurrent MI, ischemia-driven target vessel revascularization (TVR), major adverse cardiovascular events, and bleeding.

Results

A total of 1012 patients with acute MI receiving a PCI in nine trials (503 randomly assigned to hypothermia and 509 to control) were available for the quantitative synthesis. The weighted median follow-up was 30 days. As compared to controls, patients assigned to hypothermia had similar risk of all-cause death (risk ratio, [95% confidence intervals], 1.25 [0.80; 1.95], p = 0.32), with a trend toward higher risk of ischemia-driven TVR (3.55 [0.80; 15.87], p = 0.09) mostly due to acute or subacute stent thrombosis. Although in the overall cohort, infarct size was comparable between groups (standardized mean difference [95% Confidence intervals], 0.06 [− 0.92; 1.04], p = 0.92), patients effectively achieving the protocol-defined target temperature in the hypothermia group had smaller infarct size as compared to controls (p for interaction = 0.016). Treatment strategies did not differ with respect to the other outcomes.

Conclusions

As compared to standard of care, systemic therapeutic hypothermia in acute MI patients treated with PCI provided similar mortality with a signal toward more frequent repeat revascularization. Among patients assigned to hypothermia, those effectively achieving the protocol-defined target temperature displayed smaller infarct size.

Trial Registration

PROSPERO, CRD42019138754.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Ndrepepa G, Kastrati A (2016) Mechanical strategies to enhance myocardial salvage during primary percutaneous coronary intervention in patients with STEMI. EuroIntervention 12(3):319–328CrossRef
4.
Davidson SM, Ferdinandy P, Andreadou I, Botker HE, Heusch G, Ibanez B, Ovize M, Schulz R, Yellon DM, Hausenloy DJ, Garcia-Dorado D (2019) Multitarget strategies to reduce myocardial ischemia/reperfusion injury. J Am Coll Cardiol 73(1):89–99CrossRef
5.
Hausenloy DJ, Yellon DM (2013) Myocardial ischemia-reperfusion injury: a neglected therapeutic target. J Clin Invest 123(1):92–100CrossRef
6.
Erlinge D, Gotberg M, Lang I, Holzer M, Noc M, Clemmensen P, Jensen U, Metzler B, James S, Botker HE, Omerovic E, Engblom H, Carlsson M, Arheden H, Ostlund O, Wallentin L, Harnek J, Olivecrona GK (2014) Rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction. The CHILL-MI trial: a randomized controlled study of the use of central venous catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction. J Am Coll Cardiol 63(18):1857–1865CrossRef
7.
Nichol G, Strickland W, Shavelle D, Maehara A, Ben-Yehuda O, Genereux P, Dressler O, Parvataneni R, Nichols M, McPherson J, Barbeau G, Laddu A, Elrod JA, Tully GW, Ivanhoe R, Stone GW (2015) Prospective, multicenter, randomized, controlled pilot trial of peritoneal hypothermia in patients with ST-segment- elevation myocardial infarction. Circ Cardiovasc Interv 8(3):e001965CrossRef
8.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRef
9.
Juni P, Witschi A, Bloch R, Egger M (1999) The hazards of scoring the quality of clinical trials for meta-analysis. JAMA 282(11):1054–1060CrossRef
10.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269CrossRef
11.
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560CrossRef
12.
IntHout J, Ioannidis JP, Rovers MM, Goeman JJ (2016) Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open 6(7):e010247CrossRef
13.
Dixon SR, Whitbourn RJ, Dae MW, Grube E, Sherman W, Schaer GL, Jenkins JS, Baim DS, Gibbons RJ, Kuntz RE, Popma JJ, Nguyen TT, O'Neill WW (2002) Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous coronary intervention for acute myocardial infarction. J Am Coll Cardiol 40(11):1928–1934CrossRef
14.
Gotberg M, Olivecrona GK, Koul S, Carlsson M, Engblom H, Ugander M, van der Pals J, Algotsson L, Arheden H, Erlinge D (2010) A pilot study of rapid cooling by cold saline and endovascular cooling before reperfusion in patients with ST-elevation myocardial infarction. Circ Cardiovasc Interv 3(5):400–407CrossRef
15.
Noc M, Erlinge D, Neskovic AN, Kafedzic S, Merkely B, Zima E, Fister M, Petrovic M, Cankovic M, Veress G, Laanmets P, Pern T, Vukcevic V, Dedovic V, Sredniawa B, Swiatkowski A, Keeble TR, Davies JR, Warenits AM, Olivecrona G, Peruga JZ, Ciszewski M, Horvath I, Edes I, Nagy GG, Aradi D, Holzer M (2017) COOL AMI EU pilot trial: a multicentre, prospective, randomised controlled trial to assess cooling as an adjunctive therapy to percutaneous intervention in patients with acute myocardial infarction. EuroIntervention 13(5):e531–e539CrossRef
16.
Fuernau G, Beck J, Desch S, Eitel I, Jung C, Erbs S, Mangner N, Lurz P, Fengler K, Jobs A, Vonthein R, de Waha-Thiele S, Sandri M, Schuler G, Thiele H (2019) Mild hypothermia in cardiogenic shock complicating myocardial infarction. Circulation 139(4):448–457CrossRef
17.
Testori C, Beitzke D, Mangold A, Sterz F, Loewe C, Weiser C, Scherz T, Herkner H, Lang I (2019) Out-of-hospital initiation of hypothermia in ST-segment elevation myocardial infarction: a randomised trial. Heart 105(7):531–537CrossRef
18.
O'Neill WW (2003) COOL-MI: cooling as an adjunctive therapy to percutaneous intervention in patients with acute myocardial infarction. In: Presented at Transcatheter Cardiovascular Therapeutics Conference 2003, Washington DC, USA, September, 2003
19.
Grines CL (2004) ICE-IT-1: intravascular cooling adjunctive to percutaneous coronary intervention for acute myocardial infarction (part 1): a preliminary review of results. In: Presented at Transcatheter Cardiovascular Therapeutics Conference 2004, Washington DC, USA, September, 2004
20.
Dae MW, Gao DW, Sessler DI, Chair K, Stillson CA (2002) Effect of endovascular cooling on myocardial temperature, infarct size, and cardiac output in human-sized pigs. Am J Physiol Heart Circ Physiol 282(5):H1584–1591CrossRef
21.
Tissier R, Ghaleh B, Cohen MV, Downey JM, Berdeaux A (2012) Myocardial protection with mild hypothermia. Cardiovasc Res 94(2):217–225CrossRef
22.
Villablanca PA, Rao G, Briceno DF, Lombardo M, Ramakrishna H, Bortnick A, Garcia M, Menegus M, Sims D, Makkiya M, Mookadam F (2016) Therapeutic hypothermia in ST elevation myocardial infarction: a systematic review and meta-analysis of randomised control trials. Heart 102(9):712–719CrossRef
23.
Saunderson CED, Chowdhary A, Brogan RA, Batin PD, Gale CP (2016) In an era of rapid STEMI reperfusion with primary percutaneous coronary intervention is there a role for adjunct therapeutic hypothermia? A structured literature review. Int J Cardiol 223:883–890CrossRef
24.
Ndrepepa G, Mehilli J, Schwaiger M, Schuhlen H, Nekolla S, Martinoff S, Schmitt C, Dirschinger J, Schomig A, Kastrati A (2004) Prognostic value of myocardial salvage achieved by reperfusion therapy in patients with acute myocardial infarction. J Nucl Med 45(5):725–729PubMed
25.
Olivecrona GK, Gotberg M, Harnek J, Van der Pals J, Erlinge D (2007) Mild hypothermia reduces cardiac post-ischemic reactive hyperemia. BMC Cardiovasc Disord 7:5CrossRef
26.
Otterspoor LC, van Nunen LX, van't Veer M, Johnson NP, Pijls NHJ (2017) Intracoronary hypothermia before reperfusion to reduce reperfusion injury in acute myocardial infarction: a novel hypothesis and technique. Ther Hypothermia Temp Manag 7(4):199–205CrossRef
27.
El Farissi M, Keulards DCJ, van’t Veer M, Zelis JM, Berry C, De Bruyne B, Engstrom T, Frobert O, Piroth Z, Oldroyd KG, Tonino PAL, Pijls NHJ, Otterspoor LC (2019) Selective intracoronary hypothermia in patients with ST-elevation myocardial infarction. Rationale and design of the EURO-ICE Trial. EuroIntervention. https://​doi.​org/​10.​4244/​EIJ-D-19-00471CrossRefPubMed
28.
Straub A, Krajewski S, Hohmann JD, Westein E, Jia F, Bassler N, Selan C, Kurz J, Wendel HP, Dezfouli S, Yuan Y, Nandurkar H, Jackson S, Hickey MJ, Peter K (2011) Evidence of platelet activation at medically used hypothermia and mechanistic data indicating ADP as a key mediator and therapeutic target. Arterioscler Thromb Vasc Biol 31(7):1607–1616CrossRef
29.
Penela D, Magaldi M, Fontanals J, Martin V, Regueiro A, Ortiz JT, Bosch X, Sabate M, Heras M (2013) Hypothermia in acute coronary syndrome: brain salvage versus stent thrombosis? J Am Coll Cardiol 61(6):686–687CrossRef
30.
Orban M, Mayer K, Morath T, Bernlochner I, Hadamitzky M, Braun S, Schulz S, Hoppmann P, Hausleiter J, Tiroch K, Mehilli J, Schunkert H, Massberg S, Laugwitz KL, Sibbing D, Kastrati A (2015) The impact of therapeutic hypothermia on on-treatment platelet reactivity and clinical outcome in cardiogenic shock patients undergoing primary PCI for acute myocardial infarction: results from the ISAR-SHOCK registry. Thromb Res 136(1):87–93CrossRef
31.
Shah N, Chaudhary R, Mehta K, Agarwal V, Garg J, Freudenberger R, Jacobs L, Cox D, Kern KB, Patel N (2016) Therapeutic hypothermia and stent thrombosis: a nationwide analysis. JACC Cardiovasc Interv 9(17):1801–1811CrossRef
Metadata
Title
Hypothermia in patients with acute myocardial infarction: a meta-analysis of randomized trials
Authors
Brunilda Alushi
Gjin Ndrepepa
Alexander Lauten
Anna Lena Lahmann
Dario Bongiovanni
Sebastian Kufner
Erion Xhepa
Karl-Ludwig Laugwitz
Michael Joner
Ulf Landmesser
Holger Thiele
Adnan Kastrati
Salvatore Cassese
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 1/2021
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-020-01652-7

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