CLINICAL STUDY
Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous coronary intervention for acute myocardial infarction
Simon R. Dixon, MBChB, FRACP*,*,
Robert J. Whitbourn, MBBS, FRACP ,
Michael W. Dae, MD, FACC ,
Eberhard Grube, MD ,
Warren Sherman, MD, FACC||,
Gary L. Schaer, MD, FACC¶,
J. Stephen Jenkins, MD, FACC#,
Donald S. Baim, MD, FACC**,
Raymond J. Gibbons, MD, FACC,
Richard E. Kuntz, MD, FACC,
Jeffrey J. Popma, MD, FACC,
Thanh T. Nguyen, DO* and
William W. O’Neill, MD, FACC*
* William Beaumont Hospital, Royal Oak, Michigan, USA
St. Vincent’s Hospital, Melbourne, Australia
University of California San Francisco, San Francisco, California, USA
Heart Center Siegburg, Siegburg, Germany
|| Beth Israel Medical Center, New York, New York, USA
¶ Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois, USA
# Alton-Oschner Medical Center, New Orleans, Louisiana, USA
** Brigham and Women’s Hospital, Boston, Massachusetts, USA
Mayo Clinic, Rochester, Minnesota, USA
Manuscript received April 2, 2002;
revised manuscript received June 12, 2002,
accepted July 18, 2002.
* Reprint requests and correspondence: Dr. Simon R. Dixon, Division of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073, USA.
sdixon{at}smtpgw.beaumont.edu
OBJECTIVES: 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°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 99mTc-sestamibi SPECT imaging.
RESULTS: Endovascular cooling was performed successfully in 20 patients (95%). All achieved a core temperature below 34°C (mean target temperature 33.2 ± 0.9°C). The mean temperature at reperfusion was 34.7 ± 0.9°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.
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Abbreviations and Acronyms
| | AMI | | acute myocardial infarction | | MACE | | major adverse cardiac events | | PCI | | percutaneous coronary intervention | | TIMI | | Thrombolysis In Myocardial Infarction |
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