Effects of endovascular cooling on infarct size in ST-segment elevation myocardial infarction: A patient-level pooled analysis from randomized trials

Research output: Contribution to journalArticle


Objectives: This study sought to examine the relationship between temperature at reperfusion and infarct size. Background: Hypothermia consistently reduces infarct size when administered prior to reperfusion in animal studies, however, clinical results have been inconsistent. Methods: We performed a patient-level pooled analysis from six randomized control trials of endovascular cooling during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in 629 patients in which infarct size was assessed within 1 month after randomization by either single-photon emission computed tomography (SPECT) or cardiac magnetic resonance imaging (cMR). Results: In anterior infarct patients, after controlling for variability between studies, mean infarct size in controls was 21.3 (95%CI 17.4-25.3) and in patients with hypothermia <35°C it was 14.8 (95%CI 10.1-19.6), which was a statistically significant absolute reduction of 6.5%, or a 30% relative reduction in infarct size (P = 0.03). There was no significant difference in infarct size in anterior ≥35°C, or inferior infarct patients. There was no difference in the incidence of death, ventricular arrhythmias, or re-infarction due to stent thrombosis between hypothermia and control patients. Conclusions: The present study, drawn from a patient-level pooled analysis of six randomized trials of endovascular cooling during primary PCI in STEMI, showed a significant reduction in infarct size in patients with anterior STEMI who were cooled to <35°C at the time of reperfusion. The results support the need for trials in patients with anterior STEMI using more powerful cooling devices to optimize the delivery of hypothermia prior to reperfusion.


  • Michael Dae
  • William O'Neill
  • Cindy Grines
  • Simon Dixon
  • David Erlinge
  • Marko Noc
  • Michael Holzer
  • Anne Dee
External organisations
  • Wayne State University
  • William Beaumont Hospital
  • University Medical Centre Ljubljana
  • Medical University of Vienna
  • ZOLL Medical Corporation
  • University of California, San Francisco
  • Northwell Health
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • hypothermia, infarct size, STEMI
Original languageEnglish
Pages (from-to)269-276
Number of pages8
JournalJournal of Interventional Cardiology
Issue number3
Publication statusPublished - 2018 Jun 1
Publication categoryResearch