Out-of-hospital initiation of hypothermia in ST-segment elevation myocardial infarction: a randomised trial.

ABSTRACT: OBJECTIVE:To evaluate the effect of prereperfusion hypothermia initiated in the out-of-hospital setting in awake patients with ST-segment elevation myocardial infarction (STEMI) on myocardial salvage measured by cardiac MRI (CMR). METHODS:Hypothermia was initiated within 6?hours of symptom onset by the emergency medical service with surface cooling pads and cold saline, and continued in the cath lab with endovascular cooling (target temperature: ?35°C at time of reperfusion). Myocardial salvage index (using CMR) was compared in a randomised, controlled, open-label, endpoint blinded trial to a not-cooled group of patients at day 4±2 after the event. RESULTS:After postrandomisation exclusion of 19 patients a total of 101 patients were included in the intention-to-treat analysis (control group: n=54; hypothermia group: n=47). Target temperature was reached in 38/47 patients (81%) in the intervention group. Study-related interventions resulted in a delay in time from first medical contact to reperfusion of 14?min (control group 89±24?min; hypothermia group 103±21?min; p<0.01). Myocardial salvage index was 0.37 (±0.26) in the control group and 0.43 (±0.27) in the hypothermia group (p=0.27). No differences in cardiac biomarkers or clinical outcomes were found. In a CMR follow-up 6?months after the initial event no significant differences were detected. CONCLUSION:Out-of-hospital induced therapeutic hypothermia as an adjunct to primary percutaneous coronary intervention did not improve myocardial salvage in patients with STEMI. TRIAL REGISTRATION NUMBER:NCT01777750.

SUBMITTER: Testori C 

PROVIDER: S-EPMC6580740 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature