title: A pooled analysis of the effect of endovascular cooling on infarct size in patients with ST-elevation myocardial infarction.
abstract: OBJECTIVE
  Prior evaluations of endovascular cooling during primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) have suggested variability in treatment effect related to core temperature at the time of reperfusion, to infarct location and time from symptom onset to reperfusion. Recent results from a randomised feasibility study suggest rapid induction of hypothermia in primary PCI results in a significant reduction in infarct size (IS).
  
  
  RESULTS
  Outcomes from two randomised trials of hypothermia in primary PCI were pooled to examine IS as a percentage of left ventricular myocardium assessed by SPECT or magnetic resonance imaging. Compared with controls (n=103), hypothermia (n=94) was associated with a significant 24% relative reduction (RR) in IS (10.7±1.3% vs. 14.1±1.6%, mean±SEM, p=0.049). Among hypothermia-treated patients for whom core temperature <35C° was achieved before reperfusion, IS was reduced by 37% (8.8±1.7% vs. 14.1±1.6%, p=0.01), a benefit observed for both anterior (14.9±2.9% vs. 22.2±2.7%, RR 33%; p=0.03) and inferior infarcts (4.5±1.4% vs. 7.7±1.3%, RR 42%; p=0.04).
  
  
  CONCLUSIONS
  In a pooled analysis of randomised trials evaluating adjunctive hypothermia in primary PCI, achievement of core body temperature <35°C before reperfusion may reduce infarct size with a similar efficacy for both anterior and inferior MI.
authors.affiliation: Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden. david.erlinge@med.lu.se
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.forename: Kenneth
authors.initials: K
authors.lastname: Baran
authors.forename: David
authors.initials: D
authors.lastname: Kandzari
authors.forename: Göran K
authors.initials: GK
authors.lastname: Olivecrona
mesh_terms: D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D056989:Inferior Wall Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D009206:Myocardium / Q000473:pathology*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome