Advanced

Oxygen therapy in suspected acute myocardial infarction

Hofmann, Robin; James, Stefan K.; Jernberg, Tomas; Lindahl, Bertil; Erlinge, David LU ; Witt, Nils; Arefalk, Gabriel; Frick, Mats; Alfredsson, Joakim and Nilsson, Lennart, et al. (2017) In New England Journal of Medicine 377(13). p.1240-1249
Abstract

BACKGROUND: The clinical effect of routine oxygen therapy in patients with suspected acute myocardial infarction who do not have hypoxemia at baseline is uncertain. METHODS: In this registry-based randomized clinical trial, we used nationwide Swedish registries for patient enrollment and data collection. Patients with suspected myocardial infarction and an oxygen saturation of 90% or higher were randomly assigned to receive either supplemental oxygen (6 liters per minute for 6 to 12 hours, delivered through an open face mask) or ambient air. RESULTS: A total of 6629 patients were enrolled. The median duration of oxygen therapy was 11.6 hours, and the median oxygen... (More)

BACKGROUND: The clinical effect of routine oxygen therapy in patients with suspected acute myocardial infarction who do not have hypoxemia at baseline is uncertain. METHODS: In this registry-based randomized clinical trial, we used nationwide Swedish registries for patient enrollment and data collection. Patients with suspected myocardial infarction and an oxygen saturation of 90% or higher were randomly assigned to receive either supplemental oxygen (6 liters per minute for 6 to 12 hours, delivered through an open face mask) or ambient air. RESULTS: A total of 6629 patients were enrolled. The median duration of oxygen therapy was 11.6 hours, and the median oxygen saturation at the end of the treatment period was 99% among patients assigned to oxygen and 97% among patients assigned to ambient air. Hypoxemia developed in 62 patients (1.9%) in the oxygen group, as compared with 254 patients (7.7%) in the ambient-air group. The median of the highest troponin level during hospitalization was 946.5 ng per liter in the oxygen group and 983.0 ng per liter in the ambient-air group. The primary end point of death from any cause within 1 year after randomization occurred in 5.0% of patients (166 of 3311) assigned to oxygen and in 5.1% of patients (168 of 3318) assigned to ambient air (hazard ratio, 0.97; 95% confidence interval [CI], 0.79 to 1.21; P=0.80). Rehospitalization with myocardial infarction within 1 year occurred in 126 patients (3.8%) assigned to oxygen and in 111 patients (3.3%) assigned to ambient air (hazard ratio, 1.13; 95% CI, 0.88 to 1.46; P=0.33). The results were consistent across all predefined subgroups. CONCLUSIONS: Routine use of supplemental oxygen in patients with suspected myocardial infarction who did not have hypoxemia was not found to reduce 1-year all-cause mortality. (Funded by the Swedish Heart–Lung Foundation and others; DETO2X-AMI ClinicalTrials.gov number, NCT01787110.)

(Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
New England Journal of Medicine
volume
377
issue
13
pages
1240 - 1249
publisher
Massachusetts Medical Society
external identifiers
  • scopus:85029161689
  • wos:000411838100007
ISSN
0028-4793
DOI
10.1056/NEJMoa1706222
language
English
LU publication?
yes
id
faf1663d-607c-4c1a-9c7c-4d6f229114d5
date added to LUP
2017-11-07 13:32:55
date last changed
2018-11-11 04:57:41
@article{faf1663d-607c-4c1a-9c7c-4d6f229114d5,
  abstract     = {<p>BACKGROUND: The clinical effect of routine oxygen therapy in patients with suspected      acute      myocardial infarction who do not have hypoxemia at baseline is uncertain.      METHODS:      In this registry-based randomized clinical trial, we used nationwide Swedish      registries      for patient enrollment and data collection. Patients with suspected myocardial      infarction      and an oxygen saturation of 90% or higher were randomly assigned to receive      either      supplemental oxygen (6 liters per minute for 6 to 12 hours, delivered through      an      open face mask) or ambient air. RESULTS: A total of 6629 patients were enrolled.      The      median duration of oxygen therapy was 11.6 hours, and the median oxygen saturation      at      the end of the treatment period was 99% among patients assigned to oxygen and      97%      among patients assigned to ambient air. Hypoxemia developed in 62 patients (1.9%)      in      the oxygen group, as compared with 254 patients (7.7%) in the ambient-air group.      The      median of the highest troponin level during hospitalization was 946.5 ng per      liter      in the oxygen group and 983.0 ng per liter in the ambient-air group. The primary      end      point of death from any cause within 1 year after randomization occurred in 5.0%      of      patients (166 of 3311) assigned to oxygen and in 5.1% of patients (168 of 3318)      assigned      to ambient air (hazard ratio, 0.97; 95% confidence interval [CI], 0.79      to 1.21;      P=0.80). Rehospitalization with myocardial infarction within 1 year occurred      in      126 patients (3.8%) assigned to oxygen and in 111 patients (3.3%) assigned to      ambient      air (hazard ratio, 1.13; 95% CI, 0.88 to 1.46; P=0.33). The results were      consistent      across all predefined subgroups. CONCLUSIONS: Routine use of supplemental      oxygen      in patients with suspected myocardial infarction who did not have hypoxemia      was      not found to reduce 1-year all-cause mortality. (Funded by the Swedish Heart–Lung      Foundation      and others; DETO2X-AMI ClinicalTrials.gov number, NCT01787110.)</p>},
  author       = {Hofmann, Robin and James, Stefan K. and Jernberg, Tomas and Lindahl, Bertil and Erlinge, David and Witt, Nils and Arefalk, Gabriel and Frick, Mats and Alfredsson, Joakim and Nilsson, Lennart and RavnFischer, Annica and Omerovic, Elmir and Kellerth, Thomas and Sparv, David and Ekelund, Ulf and Linder, Rickard and Ekström, Mattias and Lauermann, Jörg and Haaga, Urban and Pernow, John and Östlund, Ollie and Herlitz, Johan and Svensson, Leif and ,  and Yndigegn, Troels},
  issn         = {0028-4793},
  language     = {eng},
  month        = {09},
  number       = {13},
  pages        = {1240--1249},
  publisher    = {Massachusetts Medical Society},
  series       = {New England Journal of Medicine},
  title        = {Oxygen therapy in suspected acute myocardial infarction},
  url          = {http://dx.doi.org/10.1056/NEJMoa1706222},
  volume       = {377},
  year         = {2017},
}