Author + information
- Georg Fuernau,
- Johannes Beck,
- Steffen Desch,
- Ingo Eitel,
- Christian Jung,
- Sandra Erbs,
- Norman Mangner,
- Karl Fengler,
- Marcus Sandri,
- Gerhard Schuler and
- Holger Thiele
Background: In experimental animal studies and a small retrospective observational human study mild therapeutic hypothermia (MTH) has been found as possible beneficial treatment for cardiogenic shock (CS) following acute myocardial infarction (AMI). No randomized trial in CS patients addressed this question yet.
Methods: Intubated, mechanically ventilated Patients (n=40) with CS complicating AMI undergoing primary percutaneous intervention without classical indication for MTH underwent randomization in a 1:1 fashion to MTH for 24 hours or to conventional therapy. The primary endpoint was cardiac power index (CPI) after 24 h, secondary endpoints included other hemodynamical parameters as well as serial measurements of serum lactate and sublingual microcirculation.
Results: Baseline characteristics were similar between the MTH (n=20) and control group (n=20). No differences were observed for the primary endpoint CPI measured by thermodilution (MTH vs. control: 0.30 [IQR 0.09-0.36] vs. 0.32 [IQR 0.16-0.52] W/m2; p=0.32) or Fick's equation (MTH vs. control: 0.37 [IQR 0.23-0.51] vs. 0.34 [IQR 0.29-0.46] W/m2; p=0.78). Similarly, all other hemodynamical measurements and also mixed venous oxygen saturation measurements were not statistically different (p>0.05 for all). Serum lactate levels after 6, 8 and 10 hours were significantly higher in patients in the MTH group (6h: 3.3 [IQR 2.4-5.9] vs. 1.6 [IQR 1.1-2.6] mmol/L; p=0.006; 8h: 3.7 [IQR 2.4-5.8] vs. 1.5 [IQR 1.3-2.9] mmol/L; p=0.01; 10h: 2.7 [IQR 2.3-5.3] vs. 1.3 [IQR 1.0-3.8] mmol/L; p=0.02) reflecting a significant slower decline of lactate levels in the MTH group (p for interaction 0.03). No differences were observed in sublingual microcirculation measured by dark stream side field imaging (p>0.05 for all). Short-term and long-term mortality rates were similar between the groups (MTH vs. control: 30-day: 60% vs. 50%; p=0.75; 1-year: 65% vs. 65%; p>0.99).
Conclusions: In this randomized small pilot study MTH failed to show a beneficial effect in patients with CS after AMI on hemodynamic parameters, serum lactate and sublingual microcirculation.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Novel Developments in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1194-144
- 2017 American College of Cardiology Foundation