Safety and feasibility of selective intracoronary hypothermia in acute myocardial infarction

Abstract

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A pilot clinical study of adjunctive therapy with selective intracoronary hypothermia in patients with ST‐segment elevation myocardial infarction

“…In this pilot study, selective coronary artery infusion of saline at 4°C by use of a modified aspiration catheter was rapid, effective, feasible, and safe in conscious STEMI patients, which was in agreement with the previous studies . Compared to the 2.8‐Fr infusion catheter with side‐holes and OTW‐Balloon described by Otterspoor et al , the modified aspiration catheter used in our study had some excellent properties, including rapid catheter exchange, blockage of blood flow, easy crossover of the lesion, tip injection of the cold saline and thrombus aspiration as required. The mean door‐to‐flow restoration times in our hypothermia group were prolonged with 13 min ( P = 0.07), which was consistent with previous studies .…”

“…Furthermore, the optimal goal temperature before reperfusion and the cooling duration of local hypothermia is not yet exactly been known. Therefore, the dosage of infused saline and the duration of infused time selected in the present study might be arbitrary, which is concordant with previous studies . Due to the fact that no significant differences between clinical events were observed in our study, larger studies are required to elucidate whether this cooling method can improve the prognosis of STEMI patients undergoing PPCI.…”

“…Recently, this method has been tested in a human study. Otterspoor et al have confirmed the safety and feasibility of this local hypothermia by means of selective intracoronary infusion of saline at room temperature in the ischemia phase and at 4°C in the reperfusion phase at a rate of 10–30 mL/min in STEMI patients. It has been demonstrated that, using this cooling method in isolated beating pig heart model, the distal coronary temperature measured by temperature wire was approximately 2°C lower than the damaged myocardial temperature .…”

Myocardial tissue salvage is correlated with ischemic border region temperature at reperfusion

“…33 Other researchers as well as clinical trials have used cold isotonic saline delivered with conventional catheters. 12,34,35 Isotonic saline is inexpensive and readily available. The decreased complexity of this approach warrants exploration.…”

“…Although this study used autologous blood as the infusate for TH, ensuring adequate oxygen supply during reperfusion, it also required an additional vascular access or a larger insertion sheath to pull blood from the sampling port to avoid hemolysis 33 . Other researchers as well as clinical trials have used cold isotonic saline delivered with conventional catheters 12,34,35 . Isotonic saline is inexpensive and readily available.…”