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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Evaluation of Ultrafast Hypothermia Before Reperfusion in STEMI Patients trial [VELOCITY; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01655433\u0026amp;atom=%2Fspmdc%2F14%2F30%2F18.atom\u0022\u003ENCT01655433\u003C\/a\u003E] assessed the feasibility, safety, and efficacy of systemic hypothermia induced by peritoneal lavage in patients with STEMI prior to primary percutaneous intervention.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Evaluation of Ultrafast Hypothermia Before Reperfusion in STEMI Patients trial [VELOCITY; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01655433\u0026amp;atom=%2Fspmdc%2F14%2F30%2F18.atom\u0022\u003ENCT01655433\u003C\/a\u003E], presented by Gregg W. Stone, MD, Columbia University Medical Center, New York, New York, USA, assessed the feasibility, safety, and efficacy of systemic hypothermia induced by peritoneal lavage in patients with STEMI prior to primary percutaneous intervention (PCI). Patients with symptoms of STEMI between 30 minutes and 6 hours before presentation and ST-segment elevation \u2265 2 mm in \u2265 2 continuous electrocardiography (ECG) leads who were intended for PCI were randomized to PCI (n = 26) or peritoneal hypothermia followed by PCI (n = 28). Cardiac magnetic resonance imaging (MRI) was performed at 3 to 5 days and 30 \u00b1 7 days after PCI. Clinical follow-up took place at 30 days and 6 months after PCI.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAn automated peritoneal lavage system was used to induce hypothermia to a core temperature of \u2264 34.9\u00b0C (target 32.5\u00b0C), maintained for 3 hours post PCI, after which the system initiated active rewarming and fluid drainage. The primary efficacy end point was infarct size assessed by cardiac MRI on day 3 to 5. The primary safety end point was the composite rate of death, reinfarction, ischemia-driven target vessel revascularization, major bleeding, sepsis, pneumonia, peritonitis, severe arrhythmia, or renal failure occurring within 30 \u00b1 7 days.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EPCI was performed in 25 of 26 patients randomized to PCI without hypothermia. Peritoneal access was attempted in 26 of 27 patients randomized to hypothermia followed by PCI. One of the 28 patients did not have peritoneal access or PCI and underwent surgery for aortic dissection. Peritoneal access was successful and hypothermia established in 26 of the 27 patients in whom access was attempted. PCI was performed in 27 patients.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe goal temperature of \u2264 34.9\u00b0C before PCI was achieved in 24 of 27 patients in the hypothermia group (88.9%) at a median 17.0 minutes after cooling onset. There were no significant differences in angiographic and ECG outcomes between the hypothermia and control groups. Cardiac MRI results at day 3 to 5 demonstrated no significant differences between the hypothermia and control groups in any parameters, including infarct size (\u003Cem\u003EP\u003C\/em\u003E = .54; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11887\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11887\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11887\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ECardiac MRI Results at Day 3 to 5\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EA prespecified subgroup analysis found no significant difference in infarct size at day 3 to 5 between patients in the hypothermia and control groups with left anterior descending (LAD) artery infarct (\u003Cem\u003EP\u003C\/em\u003E = .68), non-LAD artery infarct (\u003Cem\u003EP\u003C\/em\u003E = .11), and symptom onset to hospital arrival \u2264 3 hours (\u003Cem\u003EP\u003C\/em\u003E = .17) or \u0026gt; 3 hours (\u003Cem\u003EP\u003C\/em\u003E = .39).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe primary safety composite end point occurred in 21.4% of hypothermia patients vs 0.0% of controls (\u003Cem\u003EP\u003C\/em\u003E = .02). There were no significant differences between the hypothermia and control groups in the major adverse cardiac event (MACE) and stent thrombosis rates.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ELimitations of this study included the sample size, which was not powered for efficacy. The study was unblinded. Both nonanterior and anterior infarcts were included. The level of optimal cooling before PCI is unknown. Long-term follow-up was not available.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EControlled systemic hypothermia through automated peritoneal lavage may be rapidly established in patients with evolving STEMI undergoing primary PCI at the expense of a modest increase in door-to-balloon time, concluded Dr Stone. In this trial, peritoneal hypothermia was associated with an increased rate of adverse events without reducing infarct size.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/30\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzotfp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzotfp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}