A Pilot Study of Rapid Cooling by Cold Saline and Endovascular Cooling Before Reperfusion in Patients With ST-Elevation Myocardial Infarction
A Pilot Study of Rapid Cooling by Cold Saline and Endovascular Cooling Before Reperfusion in Patients With ST-Elevation Myocardial Infarction
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DOI：
10.1161/circinterventions.110.957902
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发表时间：
2010-10-01
影响因子：
5.6
通讯作者：
Erlinge, David
中科院分区：
文献类型：
--
作者：
Gotberg, Matthias;Olivecrona, Goran K.;Erlinge, David
实验研究表明，在急性冠状动脉闭塞再灌注前诱导低体温可减少梗死面积。然而，以往的临床研究并没有显示出这种效果，这主要是因为大多数患者在再灌注前没有达到治疗温度。我们的目的是评估急性心肌梗死患者在再灌注前通过冷盐水输注和血管内冷却导管快速诱导低温的安全性和可行性。方法和结果：20例急性心肌梗死患者计划接受经皮冠状动脉介入治疗，纳入这项前瞻性、随机研究。在4 +/- 2天后，分别采用t2加权成像和晚期钆增强成像心脏磁共振评估危险心肌和梗死面积。再灌注前达到核心体温< 35℃（34.7 +/- 0.3℃），门到球囊时间无明显延迟（43 +/- 7分钟vs 40 +/- 6分钟，低温与对照组，P = 0.12）。尽管缺血持续时间相似（174 +/- 51分钟vs 174 +/- 62分钟，低温与对照组相比，P = 1.00），但与对照组相比，低温组归一化到危险心肌的梗死面积减少了38% （29.8 +/- 12.6% vs 48.0 +/- 21.6%, P = 0.041）。低体温组肌钙蛋白T的峰值和累积释放量均显著降低（P = 0.01和P = 0.03）。结论：该方案表明，所有患者在再灌注前均可达到< 35℃的核心体温，而不会延迟初次经皮冠状动脉介入治疗，并且在MRI测量的3天内，将低温联合作为急性心肌梗死的辅助治疗可减少梗死面积。
Background-Experimental studies have shown that induction of hypothermia before reperfusion of acute coronary occlusion reduces infarct size. Previous clinical studies, however, have not been able to show this effect, which is believed to be mainly because therapeutic temperature was not reached before reperfusion in the majority of the patients. We aimed to evaluate the safety and feasibility of rapidly induced hypothermia by infusion of cold saline and endovascular cooling catheter before reperfusion in patients with acute myocardial infarction.Methods and Results-Twenty patients with acute myocardial infarction scheduled to undergo primary percutaneous coronary intervention were enrolled in this prospective, randomized study. After 4 +/- 2 days, myocardium at risk and infarct size were assessed by cardiac magnetic resonance using T2-weighted imaging and late gadolinium enhancement imaging, respectively. A core body temperature of < 35 degrees C (34.7 +/- 0.3 degrees C) was achieved before reperfusion without significant delay in door-to-balloon time (43 +/- 7 minutes versus 40 +/- 6 minutes, hypothermia versus control, P = 0.12). Despite similar duration of ischemia (174 +/- 51 minutes versus 174 +/- 62 minutes, hypothermia versus control, P = 1.00), infarct size normalized to myocardium at risk was reduced by 38% in the hypothermia group compared with the control group (29.8 +/- 12.6% versus 48.0 +/- 21.6%, P = 0.041). This was supported by a significant decrease in both peak and cumulative release of Troponin T in the hypothermia group (P = 0.01 and P = 0.03, respectively).Conclusions-The protocol demonstrates the ability to reach a core body temperature of < 35 degrees C before reperfusion in all patients without delaying primary percutaneous coronary intervention and that combination hypothermia as an adjunct therapy in acute myocardial infarction may reduce infarct size at 3 days as measured by MRI.