title: 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.
abstract: OBJECTIVE
  The aim of this study was to confirm the cardioprotective effects of hypothermia using a combination of cold saline and endovascular cooling.
  
  
  BACKGROUND
  Hypothermia has been reported to reduce infarct size (IS) in patients with ST-segment elevation myocardial infarctions.
  
  
  METHODS
  In a multicenter study, 120 patients with ST-segment elevation myocardial infarctions (<6 h) scheduled to undergo percutaneous coronary intervention were randomized to hypothermia induced by the rapid infusion of 600 to 2,000 ml cold saline and endovascular cooling or standard of care. Hypothermia was initiated before percutaneous coronary intervention and continued for 1 h after reperfusion. The primary end point was IS as a percent of myocardium at risk (MaR), assessed by cardiac magnetic resonance imaging at 4 ± 2 days.
  
  
  RESULTS
  Mean times from symptom onset to randomization were 129 ± 56 min in patients receiving hypothermia and 132 ± 64 min in controls. Patients randomized to hypothermia achieved a core body temperature of 34.7°C before reperfusion, with a 9-min longer door-to-balloon time. Median IS/MaR was not significantly reduced (hypothermia: 40.5% [interquartile range: 29.3% to 57.8%; control: 46.6% [interquartile range: 37.8% to 63.4%]; relative reduction 13%; p = 0.15). The incidence of heart failure was lower with hypothermia at 45 ± 15 days (3% vs. 14%, p < 0.05), with no mortality. Exploratory analysis of early anterior infarctions (0 to 4 h) found a reduction in IS/MaR of 33% (p < 0.05) and an absolute reduction of IS/left ventricular volume of 6.2% (p = 0.15).
  
  
  CONCLUSIONS
  Hypothermia induced by cold saline and endovascular cooling was feasible and safe, and it rapidly reduced core temperature with minor reperfusion delay. The primary end point of IS/MaR was not significantly reduced. Lower incidence of heart failure and a possible effect in patients with early anterior ST-segment elevation myocardial infarctions need confirmation. (Efficacy of Endovascular Catheter Cooling Combined With Cold Saline for the Treatment of Acute Myocardial Infarction [CHILL-MI]; NCT01379261).
authors: Department of Cardiology, Lund University, Lund, Sweden. Electronic address: david.erlinge@med.lu.se.
authors: David
authors: D
authors: Erlinge
authors: Department of Cardiology, Lund University, Lund, Sweden.
authors: Matthias
authors: M
authors: Götberg
authors: Department of Cardiology and the Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors: Irene
authors: I
authors: Lang
authors: Department of Cardiology and the Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors: Michael
authors: M
authors: Holzer
authors: Center for Intensive Internal Medicine, Ljubljana, Slovenia.
authors: Marko
authors: M
authors: Noc
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors: Peter
authors: P
authors: Clemmensen
authors: Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
authors: Ulf
authors: U
authors: Jensen
authors: Department of Cardiology, Medical University of Innsbruck, Innsbruck, Austria.
authors: Bernhard
authors: B
authors: Metzler
authors: Uppsala Clinical Research Center, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors: Stefan
authors: S
authors: James
authors: Department of Cardiology, Sahlgrenska University, Gothenburg, Sweden.
authors: Hans Erik
authors: HE
authors: Bötker
authors: Department of Cardiology, Sahlgrenska University, Gothenburg, Sweden.
authors: Elmir
authors: E
authors: Omerovic
authors: Department of Clinical Physiology, Lund University, Lund, Sweden.
authors: Henrik
authors: H
authors: Engblom
authors: Department of Clinical Physiology, Lund University, Lund, Sweden.
authors: Marcus
authors: M
authors: Carlsson
authors: Department of Clinical Physiology, Lund University, Lund, Sweden.
authors: Håkan
authors: H
authors: Arheden
authors: Uppsala Clinical Research Center, Uppsala, Sweden.
authors: Ollie
authors: O
authors: Ostlund
authors: Uppsala Clinical Research Center, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors: Lars
authors: L
authors: Wallentin
authors: Department of Cardiology, Lund University, Lund, Sweden.
authors: Jan
authors: J
authors: Harnek
authors: Department of Cardiology, Lund University, Lund, Sweden.
authors: Göran K
authors: GK
authors: Olivecrona
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000379:methods*; D003080:Cold Temperature; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012965:Sodium Chloride
keywords: STEMI; cardioprotection; hypothermia