Impact of Natural Mild Hypothermia in the Early Phase of ST-Elevation Myocardial Infarction: Cardiac Magnetic Resonance Imaging Study
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BACKGROUND: Mild hypothermia (32–35°C) during acute myocardial ischemia has beenconsidered cardioprotective in animal studies. We sought to determine the associationof between natural mild hypothermia and myocardial salvage as assessed by cardiacmagnetic resonance imaging (CMR) in ST-elevation myocardial infarction (STEMI) patientsundergoing primary percutaneous coronary intervention (PCI). METHODS: In 291 patients with STEMI, CMR was performed a median of 3 days after the indexevent. Body temperature was collected for 24 hours after PCI. Fifty-one patients (17.5%) hadnatural mild hypothermia (less than 35°C) during the day after PCI, and 240 (82.5%) did not. RESULTS: The primary endpoint, the myocardial salvage index, was significantly higher in thenatural mild hypothermia group than in the normothermia group (median [IQR], 50 [37–64]vs. 43 [30–56], p = 0.013). The myocardial area at risk between the 2 groups did not differ (39[22–51] vs. 35 [24–44], p = 0.361), nor did the infarct size (16 [10–28] vs. 20 [12–27], p = 0.301),presence of microvascular obstruction (57% vs. 60%, p=0.641), or hemorrhagic infarction(43% vs. 46%, p = 0.760). A multivariable linear regression showed a significant associationbetween the lowest body temperature and myocardial salvage index (β = -0.191, p = 0.001). CONCLUSIONS: In patients with STEMI undergoing primary PCI, natural mild hypothermiawithin 24 hours is associated with greater salvaged myocardium.
Abstract
BACKGROUND: Mild hypothermia (32–35°C) during acute myocardial ischemia has beenconsidered cardioprotective in animal studies. We sought to determine the associationof between natural mild hypothermia and myocardial salvage as assessed by cardiacmagnetic resonance imaging (CMR) in ST-elevation myocardial infarction (STEMI) patientsundergoing primary percutaneous coronary intervention (PCI). METHODS: In 291 patients with STEMI, CMR was performed a median of 3 days after the indexevent. Body temperature was collected for 24 hours after PCI. Fifty-one patients (17.5%) hadnatural mild hypothermia (less than 35°C) during the day after PCI, and 240 (82.5%) did not. RESULTS: The primary endpoint, the myocardial salvage index, was significantly higher in thenatural mild hypothermia group than in the normothermia group (median [IQR], 50 [37–64]vs. 43 [30–56], p = 0.013). The myocardial area at risk between the 2 groups did not differ (39[22–51] vs. 35 [24–44], p = 0.361), nor did the infarct size (16 [10–28] vs. 20 [12–27], p = 0.301),presence of microvascular obstruction (57% vs. 60%, p=0.641), or hemorrhagic infarction(43% vs. 46%, p = 0.760). A multivariable linear regression showed a significant associationbetween the lowest body temperature and myocardial salvage index (β = -0.191, p = 0.001). CONCLUSIONS: In patients with STEMI undergoing primary PCI, natural mild hypothermiawithin 24 hours is associated with greater salvaged myocardium.
참고문헌 (15)
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