title: In an era of rapid STEMI reperfusion with Primary Percutaneous Coronary Intervention is there a role for adjunct therapeutic hypothermia? A structured literature review.
abstract: Mild hypothermia has been shown to improve neurological outcome and reduce mortality following out of hospital cardiac arrest. In animal models the application of hypothermia with induced coronary occlusion has demonstrated a reduction in infarct size. Consequently, hypothermia has been proposed as a treatment, in addition to Primary Percutaneous Coronary Intervention (PPCI) for ST segment elevation myocardial infarction (STEMI). However, there is incomplete understanding of the mechanism and magnitude of the protective effect of hypothermia on the myocardium, and limited outcome data. We undertook a structured literature review of therapeutic hypothermia as adjuvant to PPCI for acute STEMI. We examined the feasibility, safety, impact on infarct size and the resultant effect on major adverse cardiac events and mortality. There were 13 studies between 1946 and 2016. With the exception of one study, therapeutic hypothermia for STEMI was reported to be feasible and safe, and its only demonstrable benefit was a modest reduction in post-infarct heart failure events. Evidence to date, however, is from small clinical trials and in an era of low early mortality following PPCI for STEMI, demonstrating a mortality benefit will be challenging. Post-myocardial infarction left ventricular dysfunction is a more frequent, alternative clinical outcome and therefore any intervention that mitigates this warrants further investigation.
authors: Department of Cardiology, Bradford Teaching Hospital NHS Trust, Bradford, West Yorkshire, UK. Electronic address: chrissaunderson@doctors.org.uk.
authors: Christopher E D
authors: CED
authors: Saunderson
authors: Department of Cardiology, Leeds Teaching Hospital NHS Trust, Leeds, West Yorkshire, UK.
authors: Amrit
authors: A
authors: Chowdhary
authors: Department of Cardiology, Doncaster and Bassetlaw NHS Trust, Doncaster, South Yorkshire, UK.
authors: Richard A
authors: RA
authors: Brogan
authors: Department of Cardiology, Mid Yorkshire NHS Trust, Wakefield, West Yorkshire, UK.
authors: Phillip D
authors: PD
authors: Batin
authors: Medical Research Council Bioinformatics Centre, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: Christopher P
authors: CP
authors: Gale
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000517:prevention & control*
keywords: PPCI; STEMI; Therapeutic hypothermia