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JACC Cardiovasc Interv ; 9(23): 2403-2412, 2016 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-27838268

RESUMO

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°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.


Assuntos
Oclusão Coronária/terapia , Parada Cardíaca/terapia , Infarto do Miocárdio/terapia , Reperfusão Miocárdica , Miocárdio/patologia , Tempo para o Tratamento , Animais , Reanimação Cardiopulmonar , Terapia Combinada , Oclusão Coronária/diagnóstico , Oclusão Coronária/patologia , Oclusão Coronária/fisiopatologia , Modelos Animais de Doenças , Parada Cardíaca/diagnóstico , Parada Cardíaca/patologia , Parada Cardíaca/fisiopatologia , Hipotermia Induzida/efeitos adversos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Reperfusão Miocárdica/efeitos adversos , Sus scrofa , Fatores de Tempo , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/terapia
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