Long-Term Effects of Oxygen Therapy on Death or Hospitalization for Heart Failure in Patients With Suspected Acute Myocardial Infarction
Tomas Jernberg, Bertil Lindahl, Joakim Alfredsson, Ellinor Berglund, Olle Bergström, Anders Engström, David Erlinge, Johan Herlitz, Raluca Jumatate, Thomas Kellerth, Jorg Lauermann, Krister Lindmark, Markus Lingman, Lina Ljung, Carina Nilsson, Elmir Omerovic, J Pernow, Annica Ravn-Fischer, David Sparv, Troels Yndigegn, Ollie Östlund, Stefan K James, Robin Hofmann, DETO2X-SWEDEHEART Investigators, Rickard Linder, Mattias Ekstrom, Lena Forsman, Johan Herlitz, Annica RavnFischer, Elmer Omerovic, Oskar Angeras, Bjorn Hornestam, Robert Kastberg, Espen Haugen, Markus Lingman, Anna Millbourn, Anders Engstrom, Jorg Carlsson, Urban Haaga, Tomas Jernberg, John Pernow, Linda Mellbin, Dinos Verouhis, Fredrik Kjellberg, Raluca Jumatate, Lennart Malmqvist, Gull-Britt Eriksson, Thomas Kellerth, Joakim Alfredsson, Lennart Nilsson, Krister Lindmark, Tommy Pettersson, Melvin Pourbazargan, Martin Serrander, Jorg Lauermann, Jan-Erik Karlsson, Neshro Barmano, Martin Risenfors, Magnus Peterson, Yiwa Wallstrom, David Erlinge, David Sparv, Marianne Erlandsson, Robin Hoffmann, Nils Witt, Mats Frick, Leif Svensson, Ellinor Berglund, Troels Yndigegn, Stefan James, Bertil Lindahl, Gabriel Arefalk, Bo Lagerqvist, Christofer Digerfeldt, Olle Bergstrom, Thomas Kellerth, Bjorn Bystrom, Tomas Jernberg, Bertil Lindahl, Joakim Alfredsson, Ellinor Berglund, Olle Bergström, Anders Engström, David Erlinge, Johan Herlitz, Raluca Jumatate, Thomas Kellerth, Jorg Lauermann, Krister Lindmark, Markus Lingman, Lina Ljung, Carina Nilsson, Elmir Omerovic, J Pernow, Annica Ravn-Fischer, David Sparv, Troels Yndigegn, Ollie Östlund, Stefan K James, Robin Hofmann, DETO2X-SWEDEHEART Investigators, Rickard Linder, Mattias Ekstrom, Lena Forsman, Johan Herlitz, Annica RavnFischer, Elmer Omerovic, Oskar Angeras, Bjorn Hornestam, Robert Kastberg, Espen Haugen, Markus Lingman, Anna Millbourn, Anders Engstrom, Jorg Carlsson, Urban Haaga, Tomas Jernberg, John Pernow, Linda Mellbin, Dinos Verouhis, Fredrik Kjellberg, Raluca Jumatate, Lennart Malmqvist, Gull-Britt Eriksson, Thomas Kellerth, Joakim Alfredsson, Lennart Nilsson, Krister Lindmark, Tommy Pettersson, Melvin Pourbazargan, Martin Serrander, Jorg Lauermann, Jan-Erik Karlsson, Neshro Barmano, Martin Risenfors, Magnus Peterson, Yiwa Wallstrom, David Erlinge, David Sparv, Marianne Erlandsson, Robin Hoffmann, Nils Witt, Mats Frick, Leif Svensson, Ellinor Berglund, Troels Yndigegn, Stefan James, Bertil Lindahl, Gabriel Arefalk, Bo Lagerqvist, Christofer Digerfeldt, Olle Bergstrom, Thomas Kellerth, Bjorn Bystrom
Abstract
Background: In the DETO2X-AMI trial (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction), we compared supplemental oxygen with ambient air in normoxemic patients presenting with suspected myocardial infarction and found no significant survival benefit at 1 year. However, important secondary end points were not yet available. We now report the prespecified secondary end points cardiovascular death and the composite of all-cause death and hospitalization for heart failure.
Methods: In this pragmatic, registry-based randomized clinical trial, we used a nationwide quality registry for coronary care for trial procedures and evaluated end points through the Swedish population registry (mortality), the Swedish inpatient registry (heart failure), and cause of death registry (cardiovascular death). Patients with suspected acute myocardial infarction and oxygen saturation of ≥90% were randomly assigned to receive either supplemental oxygen at 6 L/min for 6 to 12 hours delivered by open face mask or ambient air.
Results: A total of 6629 patients were enrolled. Acute heart failure treatment, left ventricular systolic function assessed by echocardiography, and infarct size measured by high-sensitive cardiac troponin T were similar in the 2 groups during the hospitalization period. All-cause death or hospitalization for heart failure within 1 year after randomization occurred in 8.0% of patients assigned to oxygen and in 7.9% of patients assigned to ambient air (hazard ratio, 0.99; 95% CI, 0.84–1.18; P=0.92). During long-term follow-up (median [range], 2.1 [1.0–3.7] years), the composite end point occurred in 11.2% of patients assigned to oxygen and in 10.8% of patients assigned to ambient air (hazard ratio, 1.02; 95% CI, 0.88–1.17; P=0.84), and cardiovascular death occurred in 5.2% of patients assigned to oxygen and in 4.8% assigned to ambient air (hazard ratio, 1.07; 95% CI, 0.87–1.33; P=0.52). The results were consistent across all predefined subgroups.
Conclusions: Routine use of supplemental oxygen in normoxemic patients with suspected myocardial infarction was not found to reduce the composite of all-cause mortality and hospitalization for heart failure, or cardiovascular death within 1 year or during long-term follow-up.
Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01787110.
Keywords: death; heart failure; hospitalization; mortality; myocardial infarction; oxygen inhalation therapy; registries.
Conflict of interest statement
None.
© 2018 American Heart Association, Inc.
Source: PubMed