PT  - JOURNAL ARTICLE
AU  - Christoph Testori
AU  - Dietrich Beitzke
AU  - Andreas Mangold
AU  - Fritz Sterz
AU  - Christian Loewe
AU  - Christoph Weiser
AU  - Thomas Scherz
AU  - Harald Herkner
AU  - Irene Lang
TI  - Out-of-hospital initiation of hypothermia in ST-segment elevation myocardial infarction: a randomised trial
AID  - 10.1136/heartjnl-2018-313705
DP  - 2019 Apr 01
TA  - Heart
PG  - 531--537
VI  - 105
IP  - 7
4099  - http://heart.bmj.com/content/105/7/531.short
4100  - http://heart.bmj.com/content/105/7/531.full
SO  - Heart2019 Apr 01; 105
AB  - Objective To evaluate the effect of prereperfusion hypothermia initiated in the out-of-hospital setting in awake patients with ST-segment elevation myocardial infarction (STEMI) on myocardial salvage measured by cardiac MRI (CMR).Methods Hypothermia was initiated within 6 hours of symptom onset by the emergency medical service with surface cooling pads and cold saline, and continued in the cath lab with endovascular cooling (target temperature: ≤35°C at time of reperfusion). Myocardial salvage index (using CMR) was compared in a randomised, controlled, open-label, endpoint blinded trial to a not-cooled group of patients at day 4±2 after the event.Results After postrandomisation exclusion of 19 patients a total of 101 patients were included in the intention-to-treat analysis (control group: n=54; hypothermia group: n=47). Target temperature was reached in 38/47 patients (81%) in the intervention group. Study-related interventions resulted in a delay in time from first medical contact to reperfusion of 14 min (control group 89±24 min; hypothermia group 103±21 min; p<0.01). Myocardial salvage index was 0.37 (±0.26) in the control group and 0.43 (±0.27) in the hypothermia group (p=0.27). No differences in cardiac biomarkers or clinical outcomes were found. In a CMR follow-up 6 months after the initial event no significant differences were detected.Conclusion Out-of-hospital induced therapeutic hypothermia as an adjunct to primary percutaneous coronary intervention did not improve myocardial salvage in patients with STEMI.Trial registration number NCT01777750