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    Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model

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    Name:
    FINAL_revision_for_JACC_Intcv_ ...
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    Format:
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    Description:
    Final Accepted Manuscript
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    Author
    Kern, Karl B.
    Hanna, Joseph M.
    Young, Hayley N.
    Ellingson, Carl J.
    White, Joshua J.
    Heller, Brian
    Illindala, Uday
    Hsu, Chiu-Hsieh
    Zuercher, Mathias
    Affiliation
    University of Arizona Sarver Heart Center
    Issue Date
    2016-12
    Keywords
    cardiac arrest
    coronary angiography
    hypothermia
    myocardial infarction
    reperfusion
    resuscitation
    
    Metadata
    Show full item record
    Publisher
    ELSEVIER SCIENCE INC
    Citation
    Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model 2016, 9 (23):2403 JACC: Cardiovascular Interventions
    Journal
    JACC: Cardiovascular Interventions
    Rights
    © 2016 by the American College of Cardiology Foundation. Published by Elsevier.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    OBJECTIVES The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest. BACKGROUND Cohort studies have shown that 1 in 4 post-cardiac arrest patients without ST-segment elevation has an acutely occluded coronary artery. However, many interventional cardiologists remain unconvinced that immediate coronary angiography is needed in these patients. METHODS Thirty-two swine (mean weight 35 +/- 5 kg) were randomly assigned to 1 of the following 4 treatment groups: group A, hypothermia and reperfusion; group B, hypothermia and no reperfusion; group C, no hypothermia and reperfusion; and group D, no hypothermia and no reperfusion. The left anterior descending coronary artery was occluded with an intracoronary balloon, and ventricular fibrillation was electrically induced. Cardiopulmonary resuscitation was begun after 4 min of cardiac arrest. Defibrillation was attempted after 2 min of cardiopulmonary resuscitation. Resuscitated animals randomized to hypothermia were rapidly cooled to 34 degrees C, whereas those randomized to reperfusion had such after 45 min of left anterior descending coronary artery occlusion. RESULTS At 4 h, myocardial infarct size was calculated. Group A had the smallest infarct size at 16.1 +/- 19.6% (p < 0.05). Group C had an intermediate infarct size at 29.5 +/- 20.2%, whereas groups B and D had the largest infarct sizes at 41.5 +/- 15.5% and 41.1 +/- 15.0%, respectively. CONCLUSIONS Acute coronary occlusion is often associated with cardiac arrest, so treatment of resuscitated patients should include early coronary angiography for potential emergent reperfusion, while providing hypothermia for both brain and myocardial protection. Providing only early hypothermia, while delaying coronary angiography, is not optimal. (J Am Coll Cardiol Intv 2016; 9: 2403-12)
    Note
    12 month embargo; Available online 9 November 2016
    ISSN
    19368798
    DOI
    10.1016/j.jcin.2016.08.040
    Version
    Final accepted manuscript
    Additional Links
    http://linkinghub.elsevier.com/retrieve/pii/S1936879816314662
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jcin.2016.08.040
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