Brunilda Alushi1, Gjin Ndrepepa2, Alexander Lauten1,3, Anna Lena Lahmann2, Dario Bongiovanni4, Sebastian Kufner2, Erion Xhepa2, Karl-Ludwig Laugwitz4,5, Michael Joner2,5, Ulf Landmesser1,6,3, Holger Thiele7, Adnan Kastrati2,5, Salvatore Cassese8. 1. Department of Cardiology, University Heart Center Berlin and Charité University Medicine Berlin, Berlin, Germany. 2. Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany. 3. German Centre for Cardiovascular Research (DZHK), Berlin, Germany. 4. 1. Medizinische Klinik, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany. 5. German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany. 6. Berlin Institute of Health (BIH), Berlin, Germany. 7. Department of Internal Medicine and Cardiology, Heart Centre Leipzig At University of Leipzig, Leipzig, Germany. 8. Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany. cassese@dhm.mhn.de.
Abstract
BACKGROUND: In patients with acute myocardial infarction (MI) receiving percutaneous coronary intervention (PCI), the role of systemic therapeutic hypothermia remains controversial. We sought to investigate the role of systemic therapeutic hypothermia versus standard of care in patients with acute MI treated with PCI. METHODS: This is a study-level meta-analysis of randomized trials. The primary outcome was all-cause death. The main secondary outcome was infarct size. Other secondary outcomes were recurrent MI, ischemia-driven target vessel revascularization (TVR), major adverse cardiovascular events, and bleeding. RESULTS: A total of 1012 patients with acute MI receiving a PCI in nine trials (503 randomly assigned to hypothermia and 509 to control) were available for the quantitative synthesis. The weighted median follow-up was 30 days. As compared to controls, patients assigned to hypothermia had similar risk of all-cause death (risk ratio, [95% confidence intervals], 1.25 [0.80; 1.95], p = 0.32), with a trend toward higher risk of ischemia-driven TVR (3.55 [0.80; 15.87], p = 0.09) mostly due to acute or subacute stent thrombosis. Although in the overall cohort, infarct size was comparable between groups (standardized mean difference [95% Confidence intervals], 0.06 [- 0.92; 1.04], p = 0.92), patients effectively achieving the protocol-defined target temperature in the hypothermia group had smaller infarct size as compared to controls (p for interaction = 0.016). Treatment strategies did not differ with respect to the other outcomes. CONCLUSIONS: As compared to standard of care, systemic therapeutic hypothermia in acute MI patients treated with PCI provided similar mortality with a signal toward more frequent repeat revascularization. Among patients assigned to hypothermia, those effectively achieving the protocol-defined target temperature displayed smaller infarct size. TRIAL REGISTRATION: PROSPERO, CRD42019138754.
BACKGROUND: In patients with acute myocardial infarction (MI) receiving percutaneous coronary intervention (PCI), the role of systemic therapeutic hypothermia remains controversial. We sought to investigate the role of systemic therapeutic hypothermia versus standard of care in patients with acute MI treated with PCI. METHODS: This is a study-level meta-analysis of randomized trials. The primary outcome was all-cause death. The main secondary outcome was infarct size. Other secondary outcomes were recurrent MI, ischemia-driven target vessel revascularization (TVR), major adverse cardiovascular events, and bleeding. RESULTS: A total of 1012 patients with acute MI receiving a PCI in nine trials (503 randomly assigned to hypothermia and 509 to control) were available for the quantitative synthesis. The weighted median follow-up was 30 days. As compared to controls, patients assigned to hypothermia had similar risk of all-cause death (risk ratio, [95% confidence intervals], 1.25 [0.80; 1.95], p = 0.32), with a trend toward higher risk of ischemia-driven TVR (3.55 [0.80; 15.87], p = 0.09) mostly due to acute or subacute stent thrombosis. Although in the overall cohort, infarct size was comparable between groups (standardized mean difference [95% Confidence intervals], 0.06 [- 0.92; 1.04], p = 0.92), patients effectively achieving the protocol-defined target temperature in the hypothermia group had smaller infarct size as compared to controls (p for interaction = 0.016). Treatment strategies did not differ with respect to the other outcomes. CONCLUSIONS: As compared to standard of care, systemic therapeutic hypothermia in acute MI patients treated with PCI provided similar mortality with a signal toward more frequent repeat revascularization. Among patients assigned to hypothermia, those effectively achieving the protocol-defined target temperature displayed smaller infarct size. TRIAL REGISTRATION: PROSPERO, CRD42019138754.
Authors: Mohamed El Farissi; Daniëlle C J Keulards; Marcel van 't Veer; Jo M Zelis; Colin Berry; Bernard De Bruyne; Thomas Engstrøm; Ole Fröbert; Zsolt Piroth; Keith G Oldroyd; Pim A L Tonino; Nico H J Pijls; Luuk C Otterspoor Journal: EuroIntervention Date: 2021-04-20 Impact factor: 6.534
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