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Hypothermia in patients with acute myocardial infarction: a meta-analysis of randomized trials

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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.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors

Contributions

BA, GN, AL, ALL, DB, SK, EX, AK, and SC were involved in study conception and design. SC performed the data analysis. BA, K-LL, MJ, UL, and AK supervised the data analysis. BA together with AL, GN, AK, and SC wrote the first draft of the manuscript. BA, GN, AL, ALL, DB, SK, EX, K-LL, MJ, UL, HT, AK, and SC were involved in data acquisition and revised the manuscript for important intellectual contents. All authors had full access to all the data, including statistical reports and tables and approved the manuscript for final submission.

Corresponding author

Correspondence to Salvatore Cassese.

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Conflict of interest

MJ is consultant for Biotronik and OrbusNeich. The other authors declare no potential conflict of interest.

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Alushi, B., Ndrepepa, G., Lauten, A. et al. Hypothermia in patients with acute myocardial infarction: a meta-analysis of randomized trials. Clin Res Cardiol 110, 84–92 (2021). https://doi.org/10.1007/s00392-020-01652-7

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  • DOI: https://doi.org/10.1007/s00392-020-01652-7

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