Rapid Endovascular Catheter Core Cooling Combined With Cold Saline as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction The CHILL-MI Trial: A Randomized Controlled Study of the Use of Central Venous Catheter Core Cooling Combined With Cold Saline as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction

被引：194

作者：

Erlinge, David ^{[1
]}

Gotberg, Matthias ^{[1
]}

Lang, Irene ^{[2
,3
]}

Holzer, Michael ^{[2
,3
]}

Noc, Marko ^{[4
]}

Clemmensen, Peter ^{[5
]}

Jensen, Ulf ^{[6
]}

Metzler, Bernhard ^{[7
]}

James, Stefan ^{[8
,9
]}

Botker, Hans Erik ^{[10
]}

Omerovic, Elmir ^{[10
,11
]}

Engblom, Henrik ^{[11
]}

Carlsson, Marcus ^{[11
]}

Arheden, Hakan ^{[11
]}

Ostlund, Ollie ^{[8
]}

Wallentin, Lars ^{[8
]}

Harnek, Jan ^{[1
]}

Olivecrona, Goran K. ^{[1
]}

机构：

[1] Lund Univ, Dept Cardiol, S-22185 Lund, Sweden

[2] Med Univ Vienna, Dept Cardiol, Vienna, Austria

[3] Med Univ Vienna, Dept Emergency Med, Vienna, Austria

[4] Ctr Intens Internal Med, Ljubljana, Slovenia

[5] Rigshosp, Dept Cardiol, DK-2100 Copenhagen, Denmark

[6] Karolinska Univ Hosp, Dept Med, Cardiol Unit, Stockholm, Sweden

[7] Med Univ Innsbruck, Dept Cardiol, A-6020 Innsbruck, Austria

[8] Uppsala Clin Res Ctr, Uppsala, Sweden

[9] Uppsala Univ, Dept Med Sci, Uppsala, Sweden

[10] Sahlgrenska Univ, Dept Cardiol, Gothenburg, Sweden

[11] Lund Univ, Dept Clin Physiol, S-22185 Lund, Sweden

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2014年 / 63卷 / 18期

关键词：

cardioprotection; hypothermia; STEMI; FOLLOW-UP; HYPOTHERMIA; SIZE; REPERFUSION; TEMPERATURE; RISK; OCCLUSION; DURATION; REDUCE;

D O I：

10.1016/j.jacc.2013.12.027

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to confirm the cardioprotective effects of hypothermia using a combination of cold saline and endovascular cooling. Background Hypothermia has been reported to reduce infarct size (IS) in patients with ST-segment elevation myocardial infarctions. Methods In a multicenter study, 120 patients with ST-segment elevation myocardial infarctions (<6 h) scheduled to undergo percutaneous coronary intervention were randomized to hypothermia induced by the rapid infusion of 600 to 2,000 ml cold saline and endovascular cooling or standard of care. Hypothermia was initiated before percutaneous coronary intervention and continued for 1 h after reperfusion. The primary end point was IS as a percent of myocardium at risk (MaR), assessed by cardiac magnetic resonance imaging at 4 +/- 2 days. Results Mean times from symptom onset to randomization were 129 +/- 56 min in patients receiving hypothermia and 132 +/- 64 min in controls. Patients randomized to hypothermia achieved a core body temperature of 34.7 degrees C before reperfusion, with a 9-min longer door-to-balloon time. Median IS/MaR was not significantly reduced (hypothermia: 40.5% [interquartile range: 29.3% to 57.8%; control: 46.6% [interquartile range: 37.8% to 63.4%]; relative reduction 13%; p = 0.15). The incidence of heart failure was lower with hypothermia at 45 +/- 15 days (3% vs. 14%, p < 0.05), with no mortality. Exploratory analysis of early anterior infarctions (0 to 4 h) found a reduction in IS/MaR of 33% (p < 0.05) and an absolute reduction of IS/left ventricular volume of 6.2% (p = 0.15). Conclusions Hypothermia induced by cold saline and endovascular cooling was feasible and safe, and it rapidly reduced core temperature with minor reperfusion delay. The primary end point of IS/MaR was not significantly reduced. Lower incidence of heart failure and a possible effect in patients with early anterior ST-segment elevation myocardial infarctions need confirmation. (Efficacy of Endovascular Catheter Cooling Combined With Cold Saline for the Treatment of Acute Myocardial Infarction [CHILL-MI]; NCT01379261) (C) 2014 by the American College of Cardiology Foundation

引用

页码：1857 / 1865

页数：9

共 29 条

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