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

Alushi B, Ndrepepa G, Lauten A, Lahmann AL, Bongiovanni D, Kufner S, Xhepa E, Laugwitz KL, Joner M, Landmesser U, Thiele H, Kastrati A, Cassese S (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Clinical Research in Cardiology Springer Verlag (Germany)

Book Volume: 110

Pages Range: 84-92

Journal Issue: 1

DOI: 10.1007/s00392-020-01652-7

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.

Involved external institutions

Charité - Universitätsmedizin Berlin DE Germany (DE) Technische Universität München (TUM) DE Germany (DE) Universität Leipzig DE Germany (DE)

How to cite

APA:

Alushi, B., Ndrepepa, G., Lauten, A., Lahmann, A.L., Bongiovanni, D., Kufner, S.,... Cassese, S. (2021). Hypothermia in patients with acute myocardial infarction: a meta-analysis of randomized trials. Clinical Research in Cardiology, 110(1), 84-92. https://doi.org/10.1007/s00392-020-01652-7

MLA:

Alushi, Brunilda, et al. "Hypothermia in patients with acute myocardial infarction: a meta-analysis of randomized trials." Clinical Research in Cardiology 110.1 (2021): 84-92.

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