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Therapeutic Hypothermia for Myocardial Protection in ST Elevation Myocardial Infarction

Gabriel A. Delgado, Alexander G. Truesdell and J. Dawn Abbott

Following the return of spontaneous circulation after cardiac arrest, the use of therapeutic hypothermia (TH) has been demonstrated to improve neurologic outcomes and mortality. The potential cardiac benefits and the role of induced hypothermia as a cardioprotective strategy are less clear. Numerous laboratory and clinical studies implicate both inciting myocardial ischemia and subsequent reperfusion damage in myocardial injury. Based on its established benefit in limiting cerebral ischemia and its widespread availability, TH is an attractive therapy for limiting myocardial ischemia and reperfusion injury in myocardial infarction. Several studies have suggested a positive effect of TH in the prevention of myocardial ischemic injury but to date no clinical trial has conclusively shown mortality benefit with the use of TH in the setting of ST elevation myocardial infarction (STEMI). Subgroup analyses however indicate that TH has the potential to limit infarct size and improve outcomes in certain patient subsets. These findings, alongside the established benefits for cerebral ischemic injury, support performing further large scale randomized controlled trials of the use of TH in STEMI.