Advanced

Is high flow oxygen treatment beneficial or detrimental for normoxic patients undergoing percutaneous coronary intervention for first time ST-elevation myocardial infarction; an interim analysis of the SOCCER-study.

Olofsson, Joakim LU and Galeano, Martin LU (2012) LÄKM01 20121
MD Programme
Abstract
Background: Routine oxygen therapy has for a long time been used as part of the standard treatment for myocardial infarction (MI), despite a lack of randomized controlled trials (RCT) to support the use. A recent Cochrane review on oxygen treatment for normoxic MI patients found no evidence supporting the use, rather the trend pointed towards possible harm for oxygen. The SOCCER-study (Supplemental Oxygen in Catheterized Coronary Emergency Reperfusion) is an ongoing RCT to address this question.

Objective: The aim of this study was to compare infarct size as measured by wall motion score index (WMSI) on transthoracic echocardiography (TTE) for the first patients included in SOCCER with ST-elevation myocardial infarction (STEMI)... (More)
Background: Routine oxygen therapy has for a long time been used as part of the standard treatment for myocardial infarction (MI), despite a lack of randomized controlled trials (RCT) to support the use. A recent Cochrane review on oxygen treatment for normoxic MI patients found no evidence supporting the use, rather the trend pointed towards possible harm for oxygen. The SOCCER-study (Supplemental Oxygen in Catheterized Coronary Emergency Reperfusion) is an ongoing RCT to address this question.

Objective: The aim of this study was to compare infarct size as measured by wall motion score index (WMSI) on transthoracic echocardiography (TTE) for the first patients included in SOCCER with ST-elevation myocardial infarction (STEMI) receiving high flow oxygen treatment versus room air.

Method: A randomized controlled trial was undertaken including 15 normoxic patients with first time STEMI accepted for immediate percutaneous coronary intervention (PCI). Patients were randomized in the ambulance to receive either 10 L O2/min or room air during the transport to and during the PCI. On day 2-4, TTE was performed and assessed for the primary outcome WMSI. Secondary outcomes included peak level Troponin T (TnT) and area under the curve (AUC) of TnT during 24 hours.

Results: There was 1 (of 8) deaths for oxygen and 1 (of 7) deaths for room air. There was no significant difference in WMSI between the groups: Median WMSI for oxygen vs room air (8 vs 6 patients) was 1.16 vs 1.28, p=0.87. Nor were there any significant difference in peak TnT and TnTAUC for oxygen vs room air (8 vs 7) patients. Median peak TnT 1700 vs 4125 ng/L, p=0,054, and TnTAUC was 931 vs 2272 ng/L/h, p=0,072 respectively.)

Conclusion: This interim analysis of the SOCCER study found no difference in infarct size as measured by WMSI or TnT between high flow oxygen and room air to patients with first time STEMI undergoing PCI. However the small number of patients in the analysis might have prevented us from detecting any difference. Large studies are urgently required to address the effects of oxygen to MI patients. Until then physicians should use care when administering oxygen to normoxic patients. (Less)
Please use this url to cite or link to this publication:
author
Olofsson, Joakim LU and Galeano, Martin LU
supervisor
organization
alternative title
Är syrgasbehandling till nytta eller skada för STEMI patienter som genomgår direkt-PCI?
course
LÄKM01 20121
year
type
H2 - Master's Degree (Two Years)
subject
keywords
PCI, STEMI, normoxic, oxygen, acyte myocardial infarction, MI, AMI, infarct size, troponin, WMSI, prehospital, ambulance
language
English
id
2682436
date added to LUP
2012-08-24 11:03:48
date last changed
2012-08-24 11:03:48
@misc{2682436,
  abstract     = {Background: Routine oxygen therapy has for a long time been used as part of the standard treatment for myocardial infarction (MI), despite a lack of randomized controlled trials (RCT) to support the use. A recent Cochrane review on oxygen treatment for normoxic MI patients found no evidence supporting the use, rather the trend pointed towards possible harm for oxygen. The SOCCER-study (Supplemental Oxygen in Catheterized Coronary Emergency Reperfusion) is an ongoing RCT to address this question.

Objective: The aim of this study was to compare infarct size as measured by wall motion score index (WMSI) on transthoracic echocardiography (TTE) for the first patients included in SOCCER with ST-elevation myocardial infarction (STEMI) receiving high flow oxygen treatment versus room air.

Method: A randomized controlled trial was undertaken including 15 normoxic patients with first time STEMI accepted for immediate percutaneous coronary intervention (PCI). Patients were randomized in the ambulance to receive either 10 L O2/min or room air during the transport to and during the PCI. On day 2-4, TTE was performed and assessed for the primary outcome WMSI. Secondary outcomes included peak level Troponin T (TnT) and area under the curve (AUC) of TnT during 24 hours.

Results: There was 1 (of 8) deaths for oxygen and 1 (of 7) deaths for room air. There was no significant difference in WMSI between the groups: Median WMSI for oxygen vs room air (8 vs 6 patients) was 1.16 vs 1.28, p=0.87. Nor were there any significant difference in peak TnT and TnTAUC for oxygen vs room air (8 vs 7) patients. Median peak TnT 1700 vs 4125 ng/L, p=0,054, and TnTAUC was 931 vs 2272 ng/L/h, p=0,072 respectively.)

Conclusion: This interim analysis of the SOCCER study found no difference in infarct size as measured by WMSI or TnT between high flow oxygen and room air to patients with first time STEMI undergoing PCI. However the small number of patients in the analysis might have prevented us from detecting any difference. Large studies are urgently required to address the effects of oxygen to MI patients. Until then physicians should use care when administering oxygen to normoxic patients.},
  author       = {Olofsson, Joakim and Galeano, Martin},
  keyword      = {PCI,STEMI,normoxic,oxygen,acyte myocardial infarction,MI,AMI,infarct size,troponin,WMSI,prehospital,ambulance},
  language     = {eng},
  note         = {Student Paper},
  title        = {Is high flow oxygen treatment beneficial or detrimental for normoxic patients undergoing percutaneous coronary intervention for first time ST-elevation myocardial infarction; an interim analysis of the SOCCER-study.},
  year         = {2012},
}