Villablanca Pedro A, Rao Gaurav, Briceno David F, Lombardo Marissa, Ramakrishna Harish, Bortnick Anna, García Mario, Menegus Mark, Sims Daniel, Makkiya Mohammed, Mookadam Farouk
Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
Heart. 2016 May;102(9):712-9. doi: 10.1136/heartjnl-2015-308559. Epub 2016 Feb 10.
Our objective is to gain a better understanding of the efficacy and safety of therapeutic hypothermia (TH) in patients with acute ST elevation myocardial infarction (STEMI) through an analysis of randomised controlled trials (RCTs).
Several RCTs have suggested a positive outcome with the use of TH in the prevention of myocardial injury in the setting of an acute STEMI. However, there are currently no clinical trials that have conclusively shown any significant benefit.
Electronic databases were used to identify RCTs of TH in the patient population with STEMI. The primary efficacy end point was major adverse cardiovascular event (MACE). Secondary efficacy end points included all-cause mortality, infarct size, new myocardial infarction and heart failure/pulmonary oedema (HF/PO). All-bleeding, ventricular arrhythmias and bradycardias were recorded as the safety end points.
Six RCTs were included in this meta-analysis, enrolling a total of 819 patients. There was no significant benefit from TH in preventing MACE (OR, 01.04; 95% CI 0.37 to 2.89), all-cause mortality (OR, 1.48; 95% CI 0.68 to 3.19), new myocardial infarction (OR, 0.99; 95% CI 0.20 to 4.94), HF/PO (OR, 0.52; 95% CI 0.15 to 1.77) or infarct size (standard difference of the mean (SDM), -0.1; 95% CI -0.23 to 0.04). However, a significant reduction of infarct size was observed with TH utilisation in anterior wall myocardial infarction (SDM, -0.23; 95% CI -0.45 to -0.02). There was no significant difference seen for the safety end points all-bleeding (OR 1.32; 95% CI 0.77 to 2.24), ventricular arrhythmias (OR, 0.85; 95% CI 0.54 to 1.36) or bradycardias (OR, 1.16; 95% CI 0.74 to 1.83).
Although TH appears to be safe in patients with STEMI, meta-analysis of published RCTs indicates that benefit is limited to reduction of infarct size in patients with anterior wall involvement with no demonstrable effect on all-cause mortality, recurrent myocardial infarction or HF/PO.
我们的目的是通过对随机对照试验（RCT）的分析，更好地了解治疗性低温（TH）在急性ST段抬高型心肌梗死（STEMI）患者中的疗效和安全性。
多项RCT表明，在急性STEMI情况下使用TH预防心肌损伤有积极结果。然而，目前尚无临床试验最终显示出任何显著益处。
使用电子数据库识别STEMI患者人群中TH的RCT。主要疗效终点是主要不良心血管事件（MACE）。次要疗效终点包括全因死亡率、梗死面积、新发心肌梗死和心力衰竭/肺水肿（HF/PO）。所有出血、室性心律失常和心动过缓被记录为安全终点。
该荟萃分析纳入了6项RCT，共纳入819例患者。TH在预防MACE（比值比[OR]，1.04；95%置信区间[CI] 0.37至2.89）、全因死亡率（OR，1.48；95% CI 0.68至3.19）、新发心肌梗死（OR，0.99；95% CI 0.20至4.94）、HF/PO（OR，0.52；95% CI 0.15至1.77）或梗死面积（平均标准差[SDM]，-0.1；95% CI -0.23至0.04）方面无显著益处。然而，在前壁心肌梗死中使用TH可观察到梗死面积显著减小（SDM，-0.23；95% CI -0.45至-0.02）。在安全终点方面，所有出血（OR 1.32；95% CI 0.77至2.24）、室性心律失常（OR，0.85；95% CI 0.54至1.36）或心动过缓（OR，1.16；95% CI 0.74至1.83）均无显著差异。
尽管TH在STEMI患者中似乎是安全的，但对已发表RCT的荟萃分析表明，益处仅限于减小前壁受累患者的梗死面积，对全因死亡率、复发性心肌梗死或HF/PO无明显影响。
