Oxygen therapy in ST-elevation myocardial infarction

• Published in: European heart journal Vol. 39; no. 29; pp. 2730 - 2739
• Main Authors: Hofmann, Robin, Witt, Nils, Lagerqvist, Bo, Jernberg, Tomas, Lindahl, Bertil, Erlinge, David, Herlitz, Johan, Alfredsson, Joakim, Linder, Rikard, Omerovic, Elmir, Angerås, Oskar, Venetsanos, Dimitrios, Kellerth, Thomas, Sparv, David, Lauermann, Jörg, Barmano, Neshro, Verouhis, Dinos, Östlund, Ollie, Svensson, Leif, James, Stefan K
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.08.2018
• Subjects: Aged; Air; Female; Humans; Male; Middle Aged; Mortality; Människan i vården; Oxygen; Oxygen Inhalation Therapy; Patient Readmission; Percutaneous Coronary Intervention; Prosthesis Failure; Reactive oxygen species; Registry-based randomized clinical trial; Reperfusion injury; Shock, Cardiogenic - etiology; ST Elevation Myocardial Infarction - therapy; ST-elevation myocardial infarction; Stents - adverse effects; Thrombosis - etiology; Oxygen; ST-elevation myocardial infarction; Reactive oxygen species; Percutaneous coronary intervention; Registry-based randomized clinical trial; Reperfusion injury
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehy326

Abstract Aims To determine whether supplemental oxygen in patients with ST-elevation myocardial infarction (STEMI) impacts on procedure-related and clinical outcomes. Methods and results The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized patients with suspected myocardial infarction (MI) to receive oxygen at 6 L/min for 6–12 h or ambient air. In this pre-specified analysis, we included only STEMI patients who underwent percutaneous coronary intervention (PCI). In total, 2807 patients were included, 1361 assigned to receive oxygen, and 1446 assigned to ambient air. The pre-specified primary composite endpoint of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year occurred in 6.3% (86 of 1361) of patients allocated to oxygen compared to 7.5% (108 of 1446) allocated to ambient air [hazard ratio (HR) 0.85, 95% confidence interval (95% CI) 0.64–1.13; P = 0.27]. There was no difference in the rate of death from any cause (HR 0.86, 95% CI 0.61–1.22; P = 0.41), rate of rehospitalization for MI (HR 0.92, 95% CI 0.57–1.48; P = 0.73), rehospitalization for cardiogenic shock (HR 1.05, 95% CI 0.21–5.22; P = 0.95), or stent thrombosis (HR 1.27, 95% CI 0.46–3.51; P = 0.64). The primary composite endpoint was consistent across all subgroups, as well as at different time points, such as during hospital stay, at 30 days and the total duration of follow-up up to 1356 days. Conclusions Routine use of supplemental oxygen in normoxemic patients with STEMI undergoing primary PCI did not significantly affect 1-year all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis.