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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
A pilot clinical study of adjunctive therapy with selective intracoronary hypothermia in patients with ST-segment
Yong-Sheng Wang1, Jian Zhang1, Ya-Fei Li1
1Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Insights
Selective intracoronary hypothermia significantly reduced infarct size in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). This novel approach shows promise for improving outcomes in STEMI treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Technology
Background:
- Intracoronary hypothermia, validated in humans, uses trans-coronary saline infusion to reduce infarct size in ST-segment elevation myocardial infarction (STEMI) animal models.
- Previous studies confirmed the feasibility and safety of intracoronary hypothermia in human subjects.
Purpose of the Study:
- To evaluate the impact of selective intracoronary hypothermia on patient outcomes.
- To assess the efficacy of intracoronary hypothermia as an adjunctive therapy during primary percutaneous coronary intervention (PPCI) for STEMI.
Main Methods:
- Sixty STEMI patients with TIMI flow grade 0/1 were randomized.
- Intracoronary hypothermia was induced using 4°C saline infusion in 30 patients.
- Infarct size (IS/myocardium at risk) was assessed via cardiac MRI at 7 days post-PPCI.
Main Results:
- Intracoronary hypothermia was safely performed, achieving a mean distal coronary artery temperature reduction of 5.8°C without increased arrhythmia or hemodynamic instability.
- Mean IS/MaR was significantly reduced in the hypothermia group (44.85% vs. 50.69%, P=0.022), particularly in anterior STEMI (46.12% vs. 55.27%, P=0.023).
- No significant difference in clinical events was observed between groups at 30-day follow-up.
Conclusions:
- Selective intracoronary hypothermia demonstrated a statistically significant reduction in infarct size when used as an adjunctive therapy to PPCI.
- These findings highlight the potential of intracoronary hypothermia and support the need for larger, powered trials to confirm efficacy.
Objectives:
We aimed to assess the effect of selective intracoronary hypothermia on outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).
Background:
Intracoronary hypothermia, the feasibility and safety of which has been validated in humans, induced by selective trans-coronary infusion of saline at different temperatures can reduce infarct size (IS) prior to reperfusion in animal models of STEMI.
Methods:
Sixty STEMI patients presenting with thrombolysis in myocardial infarction (TIMI) flow grade 0/1 were randomized after coronary artery angiography. Intracoronary hypothermia was induced by selective trans-coronary infusion of saline at 4°C to the endangered myocardium in the 30 patients. The primary endpoint, absolute IS expressed as IS/myocardium at risk (MaR), was assessed by cardiac magnetic resonance imaging at day 7 post-PPCI in 50 patients. Clinical follow-up was undertaken at day 30 after procedure.
Results:
Intracoronary hypothermia was successfully performed in hypothermia group, without increase in arrhythmia or hemodynamic instability. The mean temperature reduction of 5.8 ± 1.1°C in distal coronary artery was achieved before reperfusion. Mean IS/MaR was predominantly reduced in the hypothermia group (44.85 ± 5.89% vs. 50.69 ± 10.75%, P = 0.022), especially in the anterior STEMI subgroup (46.12 ± 7.54% vs. 55.27 ± 11.175%, P = 0.023). The clinical events appeared no statistical difference between the two groups at the 30-day follow-up.
Conclusion:
The statistical difference in IS/MaR by intracoronary hypothermia as adjunctive therapy to PPCI is an important observation and warrants a larger pivotal trial fully powered for efficacy.
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