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Oxygen therapy in ST-elevationmyocardial infarction

Hofmann, Robin; Witt, Nils; Lagerqvist, Bo; Jernberg, Tomas; Lindahl, Bertil; Erlinge, David LU ; Herlitz, Johan; Alfredsson, Joakim; Linder, Rikard and Omerovic, Elmir, et al. (2018) In European Heart Journal 39(29). p.2730-2739
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... (More)

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.

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keywords
Oxygen, Percutaneous coronary intervention, Reactive oxygen species, Registry-based randomized clinical trial, Reperfusion injury, ST-elevation myocardial infarction
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European Heart Journal
volume
39
issue
29
pages
10 pages
publisher
Oxford University Press
external identifiers
  • scopus:85054427072
ISSN
0195-668X
DOI
10.1093/eurheartj/ehy326
language
English
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yes
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f948dc12-f248-409b-a257-08612a2b183e
date added to LUP
2018-11-06 09:54:42
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2019-01-14 07:40:30
@article{f948dc12-f248-409b-a257-08612a2b183e,
  abstract     = {<p>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.</p>},
  author       = {Hofmann, Robin and Witt, Nils and Lagerqvist, Bo and Jernberg, Tomas and Lindahl, Bertil and Erlinge, David and Herlitz, Johan and Alfredsson, Joakim and Linder, Rikard and Omerovic, Elmir and Angerås, Oskar and Venetsanos, Dimitrios and Kellerth, Thomas and Sparv, David and Lauermann, Jörg and Barmano, Neshro and Verouhis, Dinos and Östlund, Ollie and Svensson, Leif and James, Stefan K.},
  issn         = {0195-668X},
  keyword      = {Oxygen,Percutaneous coronary intervention,Reactive oxygen species,Registry-based randomized clinical trial,Reperfusion injury,ST-elevation myocardial infarction},
  language     = {eng},
  number       = {29},
  pages        = {2730--2739},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Oxygen therapy in ST-elevationmyocardial infarction},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehy326},
  volume       = {39},
  year         = {2018},
}