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In vitro Assessment of Myocardial Protection following Hypothermia-Preconditioning in a Human Cardiac Myocytes Model
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Hypothermia and its role in patients with ST-segment-elevation myocardial infarction and cardiac arrest

Karsten Keller1,2,3, Ingo Sagoschen1, Volker H Schmitt1,4

  • 1Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.

Frontiers in Cardiovascular Medicine
|December 16, 2022
PubMed

Insights

Therapeutic hypothermia improves survival for ST-segment-elevation myocardial infarction (STEMI) patients after cardiac arrest and cardiopulmonary resuscitation (CPR). While associated with increased risks of stroke, pneumonia, and kidney injury, hypothermia significantly reduces in-hospital mortality.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Emergency Medicine

Background:

  • ST-segment-elevation myocardial infarction (STEMI) patients experiencing cardiac arrest have a high mortality risk.
  • Therapeutic hypothermia is recommended post-resuscitation for unconscious cardiac arrest patients, but its survival impact remains debated.
  • Previous analyses of therapeutic hypothermia in STEMI patients after cardiopulmonary resuscitation (CPR) yielded inconsistent results.

Purpose of the Study:

  • To investigate the survival benefits of therapeutic hypothermia in STEMI patients following CPR.
  • To analyze the association between therapeutic hypothermia and in-hospital mortality and adverse outcomes in STEMI patients post-CPR.

Main Methods:

  • Retrospective analysis of nationwide German inpatient data from 2005-2019.
  • Identification and stratification of STEMI patients who underwent CPR, comparing those treated with therapeutic hypothermia versus those without.
  • Statistical analysis to determine the impact of hypothermia on in-hospital mortality and adverse events.

Main Results:

  • A total of 133,070 STEMI patients with CPR were analyzed; 12.3% received therapeutic hypothermia.
  • Therapeutic hypothermia was independently associated with a reduced in-hospital case fatality rate (OR 0.83; 95% CI 0.80-0.86).
  • Hypothermia increased the risk of stroke (OR 1.37), pneumonia (OR 1.75), and acute kidney injury (OR 2.21).

Conclusions:

  • Therapeutic hypothermia demonstrates a significant survival benefit for STEMI patients after cardiac arrest and CPR.
  • Despite increased risks for certain adverse events, the overall survival advantage supports its use in this patient population.
  • Further research may explore optimizing hypothermia protocols to mitigate associated risks.
Abstract

Keywords:
PCISTEMIcardiac arresthypothermiamyocardial infarction

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