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Review
. 2022 Feb 18;11(4):1082.
doi: 10.3390/jcm11041082.

Hypothermia for Cardioprotection in Patients with St-Elevation Myocardial Infarction: Do Not Give It the Cold Shoulder Yet!

Mohamed El Farissi  1 , Thomas P Mast  1 , Mileen R D van de Kar  1 , Daimy M M Dillen  1 , Jesse P A Demandt  1 , Fabienne E Vervaat  1 , Rob Eerdekens  1 , Simon A G Dello  1 , Danielle C Keulards  1 , Jo M Zelis  1 , Marcel van 't Veer  1   2 , Frederik M Zimmermann  1 , Nico H J Pijls  1   2 , Luuk C Otterspoor  1
Affiliations
Review

Hypothermia for Cardioprotection in Patients with St-Elevation Myocardial Infarction: Do Not Give It the Cold Shoulder Yet!

Mohamed El Farissi et al. J Clin Med. .

Abstract

The timely revascularization of an occluded coronary artery is the cornerstone of treatment in patients with ST-elevation myocardial infarction (STEMI). As essential as this treatment is, it can also cause additional damage to cardiomyocytes that were still viable before reperfusion, increasing infarct size. This has been termed "myocardial reperfusion injury". To date, there is still no effective treatment for myocardial reperfusion injury in patients with STEMI. While numerous attempts have been made to overcome this hurdle with various experimental therapies, the common denominator of these therapies is that, although they often work in the preclinical setting, they fail to demonstrate the same results in human trials. Hypothermia is an example of such a therapy. Although promising results were derived from experimental studies, multiple randomized controlled trials failed to do the same. This review includes a discussion of hypothermia as a potential treatment for myocardial reperfusion injury, including lessons learned from previous (negative) trials, advanced techniques and materials in current hypothermic treatment, and the possible future of hypothermia for cardioprotection in patients with STEMI.

Keywords: PCI; STEMI; acute myocardial infarction; hypothermia; myocardial reperfusion injury.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study-level meta-analysis of randomized trials investigating systemic hypothermia for cardioprotection in STEMI and effect on infarct size and microvascular obstruction [26,27,28,29,30,31,32].
Figure 2
Figure 2
Important requirements for successful hypothermic cardioprotection in patients with ST-elevation myocardial infarction. In parentheses are the numbers related to selective intracoronary hypothermia from the ongoing EURO-ICE study.
Figure 3
Figure 3
Visualization of the infarct area before (A) and during (B) selective intracoronary hypothermia in an ex vivo beating porcine heart. The arrow indicates the myocardium at risk (MaR) during selective intracoronary hypothermia. The decrease in myocardial temperature is limited to the borders of the MaR without affecting the temperature of the healthy adjacent myocardium.
See this image and copyright information in PMC

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