title: Therapeutic hypothermia in ST elevation myocardial infarction: a systematic review and meta-analysis of randomised control trials.
abstract: OBJECTIVE
  Our objective is to gain a better understanding of the efficacy and safety of therapeutic hypothermia (TH) in patients with acute ST elevation myocardial infarction (STEMI) through an analysis of randomised controlled trials (RCTs).
  
  
  BACKGROUND
  Several RCTs have suggested a positive outcome with the use of TH in the prevention of myocardial injury in the setting of an acute STEMI. However, there are currently no clinical trials that have conclusively shown any significant benefit.
  
  
  METHODS
  Electronic databases were used to identify RCTs of TH in the patient population with STEMI. The primary efficacy end point was major adverse cardiovascular event (MACE). Secondary efficacy end points included all-cause mortality, infarct size, new myocardial infarction and heart failure/pulmonary oedema (HF/PO). All-bleeding, ventricular arrhythmias and bradycardias were recorded as the safety end points.
  
  
  RESULTS
  Six RCTs were included in this meta-analysis, enrolling a total of 819 patients. There was no significant benefit from TH in preventing MACE (OR, 01.04; 95% CI 0.37 to 2.89), all-cause mortality (OR, 1.48; 95% CI 0.68 to 3.19), new myocardial infarction (OR, 0.99; 95% CI 0.20 to 4.94), HF/PO (OR, 0.52; 95% CI 0.15 to 1.77) or infarct size (standard difference of the mean (SDM), -0.1; 95% CI -0.23 to 0.04). However, a significant reduction of infarct size was observed with TH utilisation in anterior wall myocardial infarction (SDM, -0.23; 95% CI -0.45 to -0.02). There was no significant difference seen for the safety end points all-bleeding (OR 1.32; 95% CI 0.77 to 2.24), ventricular arrhythmias (OR, 0.85; 95% CI 0.54 to 1.36) or bradycardias (OR, 1.16; 95% CI 0.74 to 1.83).
  
  
  CONCLUSIONS
  Although TH appears to be safe in patients with STEMI, meta-analysis of published RCTs indicates that benefit is limited to reduction of infarct size in patients with anterior wall involvement with no demonstrable effect on all-cause mortality, recurrent myocardial infarction or HF/PO.
authors: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
authors: Pedro A
authors: PA
authors: Villablanca
authors: Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
authors: Gaurav
authors: G
authors: Rao
authors: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
authors: David F
authors: DF
authors: Briceno
authors: Department of Internal Medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
authors: Marissa
authors: M
authors: Lombardo
authors: Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic College of Medicine, Scottsdale, Arizona, USA.
authors: Harish
authors: H
authors: Ramakrishna
authors: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
authors: Anna
authors: A
authors: Bortnick
authors: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
authors: Mario
authors: M
authors: García
authors: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
authors: Mark
authors: M
authors: Menegus
authors: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
authors: Daniel
authors: D
authors: Sims
authors: Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
authors: Mohammed
authors: M
authors: Makkiya
authors: Cardiovascular Division, Mayo Clinic College of Medicine, Scottsdale, Arizona, USA.
authors: Farouk
authors: F
authors: Mookadam
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D061214:Patient Safety; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome