Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous coronary intervention for acute myocardial infarction.
OBJECTIVE
The purpose of this study was to evaluate the safety and feasibility of endovascular cooling during primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).


BACKGROUND
In experimental models of AMI, mild systemic hypothermia has been shown to reduce metabolic demand and limit infarct size.


METHODS
In a multi-center study, 42 patients with AMI (<6 h from symptom onset) were randomized to primary PCI with or without endovascular cooling (target core temperature 33 degrees C). Cooling was maintained for 3 h after reperfusion. Skin warming, oral buspirone, and intravenous meperidine were used to reduce the shivering threshold. The primary end point was major adverse cardiac events at 30 days. Infarct size at 30 days was measured using (99m)Tc-sestamibi SPECT imaging.


RESULTS
Endovascular cooling was performed successfully in 20 patients (95%). All achieved a core temperature below 34 degrees C (mean target temperature 33.2 +/- 0.9 degrees C). The mean temperature at reperfusion was 34.7 +/- 0.9 degrees C. Cooling was well tolerated, with no hemodynamic instability or increase in arrhythmia. Nine patients experienced mild episodic shivering. Major adverse cardiac events occurred in 0% vs. 10% (p = NS) of treated versus control patients. The median infarct size was non-significantly smaller in patients who received cooling compared with the control group (2% vs. 8% of the left ventricle, p = 0.80).


CONCLUSIONS
Endovascular cooling can be performed safely as an adjunct to primary PCI for AMI. Further clinical trials are required to determine whether induction of mild systemic hypothermia with endovascular cooling will limit infarct size in patients undergoing reperfusion therapy.
Dixon
Simon R
SR
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. sdixon@smtpgw.beaumont.edu
Whitbourn
Robert J
RJ
Dae
Michael W
MW
Grube
Eberhard
E
Sherman
Warren
W
Schaer
Gary L
GL
Jenkins
J Stephen
JS
Baim
Donald S
DS
Gibbons
Raymond J
RJ
Kuntz
Richard E
RE
Popma
Jeffrey J
JJ
Nguyen
Thanh T
TT
O'Neill
William W
WW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology; D012449:Safety; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome