A cold-hearted treatment for MI could limit reperfusion injury

Temporarily cooling part of the heart during myocardial infarction (MI) and again immediately after angioplasty may reduce damage to the heart, said a cardiologist who participated in the first in-human study of the technique.

Luuk Otterspoor, an interventional cardiologist at Catharina Hospital in Eindhoven, Netherlands, compared the rationale to icing a knee after a sports collision. Cooling the muscles around the knee can reduce the inflammatory swelling reaction, and the same principle applies to the heart, Otterspoor said in a press release.

The goal is to reduce reperfusion injury, which can occur when blood supply returns to heart tissue after angioplasty, or percutaneous coronary intervention (PCI), reopens a blocked artery.

“By cooling the part of the heart that is affected by a clogged or constricted coronary artery, there is less damage to the heart muscle after the constriction is opened up. We believe that this can ultimately reduce the impact of the heart attack and damage to the heart by some 20 to 30 percent,” he said.

Otterspoor and colleagues performed the new treatment on 10 patients, showing it is “safe” and “technically possible,” according to the release. The method had been previously demonstrated in animal models but never in humans.

It involves injecting a fluid just past the closure in the coronary artery to cool the affected part of the heart down to 4 to 5 degrees Celsius (39-42 degrees Fahrenheit). The cooling process lasts 10 minutes, followed by the reopening of the coronary artery using a tiny balloon, 10 more minutes of cooling and stent placement.

The new treatment requires keeping the artery closed 10 minutes longer—potentially prolonging a patient’s chest pain—“but it is worth it in view of the health benefits in the longer term,” Otterspoor said.

According to the release, six European heart centers are set to begin a larger randomized trial to evaluate the technique. They will analyze 100 patients undergoing traditional PCI versus 100 receiving the new treatment method.