Rapid Endovascular Catheter Core Cooling Combined With Cold Saline as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction

Abstract

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).

Prospective, Multicenter, Randomized, Controlled Pilot Trial of Peritoneal Hypothermia in Patients With ST-Segment— Elevation Myocardial Infarction

“…This favorable experience prompted a multicenter trial of this cooling method in 120 randomized patients. 8 In the hypothermia group, 76% of patients achieved a core temperature <35°C, with door-to-balloon time prolonged by 10 minutes compared with control. There was no significant difference in infarct size normalized to area at risk (median 40.5% with hypothermia versus 46.6% with control, P=0.15).…”

“…1 Induction of mild hypothermia (<35°C) before reperfusion has been shown to reduce infarct size in animal models of STEMI, 2,3 as well as in small randomized trials and subgroup analyses of larger randomized trials in humans. [4][5][6][7][8][9] As smaller infarct size is strongly correlated with greater ejection fraction and improved survival, systemic hypothermia may have long-term benefits in patients with STEMI. Peritoneal Hypothermia in STEMI ensure adequate cooling before percutaneous coronary intervention (PCI).…”

Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model

“…The clinical evidence for the role of therapeutic hypothermia in limiting infarct size has been more difficult to establish. The clinical hypothermia trials in acute myocardial infarction to date have been limited by small numbers of patients and thereby lacked significant power (22)(23)(24)(25)(26)(27). However, recent pooled or combination analyses of the individual studies have shown consistent clinical benefits of limiting MI size and decreasing the development of heart failure (28,29).…”

Novel therapeutics in myocardial infarction: targeting microvascular dysfunction and reperfusion injury

“…Subsequently, the Efficacy of Endovascular Catheter Cooling Combined With Cold Saline for the Treatment of Acute Myocardial Infarction (CHILL-MI) trial randomized 120 patients with STEMI to hypothermia induced by the rapid infusion of 600-2000 ml cold saline and endovascular cooling or standard of care [113]. Hypothermia was initiated before PCI and continued for 1 h after reperfusion.…”