Oxygen Therapy in Suspected Acute Myocardial Infarction
Robin Hofmann, Stefan K James, Tomas Jernberg, Bertil Lindahl, David Erlinge, Nils Witt, Gabriel Arefalk, Mats Frick, Joakim Alfredsson, Lennart Nilsson, Annica Ravn-Fischer, Elmir Omerovic, Thomas Kellerth, David Sparv, Ulf Ekelund, Rickard Linder, Mattias Ekström, Jörg Lauermann, Urban Haaga, John Pernow, Ollie Östlund, Johan Herlitz, Leif Svensson, DETO2X–SWEDEHEART Investigators, Lena Forsman, Martin Risenfors, Oskar Angerås, Björn Hornestam, Robert Kastberg, Espen Haugen, Markus Lingman, Anna Millbourn, Anders Engström, Jörg Carlsson, Linda Mellbin, Dinos Verouhis, Fredrik Kjellberg, Raluca Jumatate, Lennart Malmqvist, Gull-Britt Eriksson, Eva Swahn, Dimitrios Venetsanos, Carina Nilsson, Krister Lindmark, Tommy Pettersson, Melvin Pourbazargan, Martin Serrander, Ivan Rosenqvist, Jan-Erik Karlsson, Neshro Barmano, Magnus Peterson, Ylwa Wallström, Marianne Erlandsson, Ellinor Berglund, Troels Yndigegn, Bo Lagerqvist, Christofer Digerfeldt, Olle Bergström, Björn Byström, Robin Hofmann, Stefan K James, Tomas Jernberg, Bertil Lindahl, David Erlinge, Nils Witt, Gabriel Arefalk, Mats Frick, Joakim Alfredsson, Lennart Nilsson, Annica Ravn-Fischer, Elmir Omerovic, Thomas Kellerth, David Sparv, Ulf Ekelund, Rickard Linder, Mattias Ekström, Jörg Lauermann, Urban Haaga, John Pernow, Ollie Östlund, Johan Herlitz, Leif Svensson, DETO2X–SWEDEHEART Investigators, Lena Forsman, Martin Risenfors, Oskar Angerås, Björn Hornestam, Robert Kastberg, Espen Haugen, Markus Lingman, Anna Millbourn, Anders Engström, Jörg Carlsson, Linda Mellbin, Dinos Verouhis, Fredrik Kjellberg, Raluca Jumatate, Lennart Malmqvist, Gull-Britt Eriksson, Eva Swahn, Dimitrios Venetsanos, Carina Nilsson, Krister Lindmark, Tommy Pettersson, Melvin Pourbazargan, Martin Serrander, Ivan Rosenqvist, Jan-Erik Karlsson, Neshro Barmano, Magnus Peterson, Ylwa Wallström, Marianne Erlandsson, Ellinor Berglund, Troels Yndigegn, Bo Lagerqvist, Christofer Digerfeldt, Olle Bergström, Björn Byström
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 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 .).
Source: PubMed