Therapeutic Hypothermia for ST-Elevation Myocardial Infarction: A Systematic Review, Pairwise, and Network Meta-Analysis

Abstract

There is a need to examine the evidence of therapeutic hypothermia (TH) safety and efficacy during the management of ST-elevation myocardial infarction. We therefore conducted a systematic review and meta-analysis synthesizing evidence from randomized controlled trials obtained from PubMed, Cochrane, Scopus, and Web of Science from inception to July 2024. We reported dichotomous outcomes using the risk ratio (RR) and continuous outcomes using the mean difference (MD) with a 95% confidence interval (CI). This study was registered with CRD42024586329 on the International Prospective Register of Systematic Reviews. Ten randomized controlled trials with 806 patients were included. There was no significant difference between both groups in major adverse cardiac event (RR: 1.50, 95% CI: 0.71–3.15, P = 0.29), microvascular obstruction (MD: 0.12, 95% CI: −0.04 to 0.29, P = 0.15), and infarct size (MD: −0.11, 95% CI: −1.65 to 1.43, P = 0.89). TH was significantly associated with longer door-to-balloon time (MD: 12.60, 95% CI: 6.75 to 18.46, P < 0.01), increased incidence of infection (RR: 3.30, 95% CI: 1.31 to 8.29, P = 0.01), and uncontrolled shivering (RR: 5.78, 95% CI: 1.60 to 20.94, P < 0.01). The available evidence does not support a benefit for TH in reducing the burden of ST-elevation myocardial infarction nor lowering the severity of infarction.