Acute Myocardial Infarction
Conditions
Keywords
ST Elevation Myocardial Infarction, Transcoronary Cooling
Brief summary
Patients with heart attacks caused by blocked coronary arteries are usually treated with a technique called primary angioplasty. Although this treatment is very successful it can result in damage to the heart muscle when the artery is opened due to reperfusion injury. Cooling the entire body has been shown to reduce heart muscle damage during heart attacks in some patients but not in others, however it is uncomfortable due to the shivering, expensive and can result in delays in opening the blocked artery. We are investigating a simpler way to cool the heart muscle directly using cooled fluid passed through the catheter without the shortcomings of entire body cooling. This pilot will address safety and feasibility considerations.
Detailed description
The precise mechanisms involved in ischaemia/reperfusion injury is not fully understood but a number of factors are thought to contribute to cardiac dysfunction14, 15. These include : 1. reperfusion arrhythmias; 2. microvascular obstruction or no-reflow phenomenon; 3. myocardial stunning and 4. cardiomyocyte apoptosis. It is estimated that ischaemia/reperfusion injury occurs in \> 30% of patients and is associated with reduced myocardial salvage and poor prognosis16-18. Ischaemia/reperfusion injury may account for up to 50% of the final infarct size9. Deep hypothermia (\< 30 °C) has long been used in protecting the heart during coronary artery bypass grafting and heart transplantation. Intermittent antegrade or retrograde infusion of cold cardioplegia appears to reduce myocardial ischaemia and improves outcome19, 20. Deep hypothermia however can cause spontaneous ventricular fibrillation and impaired cardiac function and its application is limited to the unconscious patient.
Interventions
OTHERCohort A - Room temperature coronary perfusate
Patients recruited into the study will receive standard PPCI and in addition a transcoronary infusion of Hartmans solution at room temperature (Cohort A). The research intervention is the infusion of room temperature Hartmans solution.
OTHERCohort B - Cooled coronary perfusate
Patients recruited into the study will receive standard PPCI and in addition a transcoronary infusion of Hartmans solution cooled at 15 degrees (Cohort B). The research intervention is the infusion of Hartmans solution cooled to 15 degrees.
Sponsors
Royal Brompton & Harefield NHS Foundation Trust
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Men and women aged between 18 and 80 years presenting with ischaemic chest pain of \<6 hours and STsegment elevation on the ECG of \>0.2 mV in 2 contiguous leads.
Exclusion criteria
* Patients with cardiac arrest, previous AMI or CABG, known congestive heart failure, endstage kidney disease or hepatic failure, recent stroke, coagulopathy, pregnancy, or cardiogenic shock. * Patients who are unable or unwilling to provide assent and informed consent.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Haemodynamic changes using the blood pressure (mmHg) and heart rate (beats /min) | Throughout the PPCI Procedure and for One Hour Afterwards |
| Duration and Volume of perfusate infused used (total time-mins and total volume-mls) | Throughout the PPCI Procedure and for One Hour Afterwards |
| Intracoronary temperature measured with thermistor wire | Throughout the PPCI Procedure only |
| Symptoms of Chest pain and breathlessness using a Visual Analog Scale | Throughout the PPCI Procedure and for One Hour Afterwards |
| ECG changes (ST segment shift in mm) | Throughout the PPCI Procedure and for One Hour Afterwards |
Secondary
| Measure | Time frame |
|---|---|
| Myocardial infarct size measured with MRI Heart Scan | During hospital admission |
| Biomarker rise (Cardiac troponin) | 24 hours post PCI procedure |
Countries
United Kingdom
Outcome results
None listed