The effect of oxygen inhalation on cardiac biomarkers in patients presenting with acute ST-segment elevation myocardial infraction: A randomized clinical trial (original) (raw)
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Oxygen Therapy in Suspected Acute Myocardial Infarction
New England Journal of Medicine
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.
Oxygen Therapy for Acute Myocardial Infarction—Then and Now. A Century of Uncertainty
The American Journal of Medicine, 2011
For about 100 years, inhaled oxygen has been administered to all patients suspected of having an acute myocardial infarction. The basis for this practice was the belief that oxygen supplementation raised often-deficient arterial oxygen content to improve myocardial oxygenation, thereby reducing infarct size. This assumption is conditional and not evidence-based. While such physiological changes may pertain in some patients who are hypoxemic, considerable data suggest that oxygen therapy may be detrimental in others. Acute oxygen therapy may raise blood pressure and lower cardiac index, heart rate, cardiac oxygen consumption, and blood flow in the cerebral and renal beds. Oxygen also may lower capillary density and redistribute blood in the microcirculation. Several reports now confirm that these changes occur in humans. In patients with both acute coronary syndromes and stable coronary disease, oxygen administration may constrict the coronary vessels, lower myocardial oxygen delivery, and may actually worsen ischemia. There are no large, contemporary, randomized studies that examine clinical outcomes after this intervention. Hence, this long-accepted but potentially harmful tradition urgently needs reevaluation. Clinical guidelines appear to be changing, favoring use of oxygen only in hypoxemic patients, and then cautiously titrating to individual oxygen tensions.
Air Versus Oxygen in ST-Segment Elevation Myocardial Infarction
Circulation, 2015
Au u ust st stra ra rali li lia; a; a; 3 We W W st st ste e ern Health, Melbourne, Austral al alia ia ia 4 Ambulance Victor r ria ia ia, , , Melbourne, Australia; 5 Mo Mo Monash Uni ni nive e ers rs rsit i i y, y, , M M Mel el elbo bo bour r rne ne ne, , , Au Au Aust st stra ra ralia; a; a; 6 Un U U iv ver r rsity y y o o of f f We W W st st ster er ern n n Au Au Aust st stra r r lia, a, a, W W Wes es este t rn n A A Aus us ustr tr tral al alia t t t Au u ustralia a a; 7 7 Monash h h M Med d dic c cal C Cen n ntre, , , Me Me Melb b bourn rn rne, Au u ust tral l lia a a * Se Se S e e e Su Su Supp p p le e eme me ment nt ntal al al M M Mat at ater er eria ia ial fo fo for r r a a a c co comp mp mple le lete te te l l lis is ist of of of i i inv nv nve e esti ti tiga ga g to to tors rs rs by guest on October 28, 2016 Abstract Background-Oxygen is commonly administered to patients with ST-elevation myocardial infarction (STEMI) despite previous studies suggesting a possible increase in myocardial injury due to coronary vasoconstriction and heightened oxidative stress. Methods and Results-We conducted a multicenter, prospective, randomized, controlled trial comparing oxygen (8 L/min) with no supplemental oxygen in patients with STEMI diagnosed on paramedic 12-lead electrocardiogram. Of 638 patients randomized, 441 were confirmed STEMI patients who underwent primary endpoint analysis. The primary endpoint was myocardial infarct size as assessed by cardiac enzymes, troponin (cTnI) and creatine kinase (CK). Secondary endpoints included recurrent myocardial infarction, cardiac arrhythmia and myocardial infarct size assessed by cardiac magnetic resonance (CMR) imaging at 6 months. Mean peak troponin was similar in the oxygen and no oxygen groups (57.4 mcg/L vs. 48.0 mcg/L; ratio, 1.20; 95% confidence interval [CI], 0.92 to 1.56; P=0.18). There was a significant increase in mean peak CK in the oxygen group compared to the no oxygen group (1948 U/L vs. 1543 U/L; means ratio, 1.27; 95% CI, 1.04 to 1.52; P= 0.01). There was an increase in the rate of recurrent myocardial infarction in the oxygen group compared to the no oxygen group (5.5%vs.0.9%, P=0.006) and an increase in frequency of cardiac arrhythmia (40.4% vs. 31.4%; P=0.05). At 6-months the oxygen group had an increase in myocardial infarct size on CMR (n=139; 20.3 grams vs. 13.1 grams; P=0.04). Conclusions-Supplemental oxygen therapy in patients with STEMI but without hypoxia may increase early myocardial injury and was associated with larger myocardial infarct size assessed at six months. Clinical Trial Registration Information-clinicaltrials.gov. Identifier: NCT01272713. Key words: myocardial infarction, ST-segment elevation myocardial infarction, oxygen ize assessed by cardiac magnetic resonance (CMR) imaging at 6 months. Mean peak k troponin was similar in the oxygen and no oxygen groups (57.4 mcg/L vs. 48.0 mcg/L; rat ti i io, , , 1. . .20 20 20; ; ; 95 95 95% confidence interval [CI], 0.92 to 1.56; P=0.18). There was a significant increase in mean peak CK in the oxyg y y en n g group compared to the no oxyg gen en group (1948 U/L vs. s. 1543 U/L; means ratio, 1. .27 27 27; ; 95% CI CI CI, , 1.04 to 1.52; P= 0.01). There was a an increase in th h he e e rate of recurrent myocardial n n nfa a arction in the ox xygen en en group up up com m mp p par r red d to th h he no o o o oxy y yge ge gen g gr group p p (5.5% % %vs s.0. . .9% 9% 9%, P= P= P=0 0 0.00 0 06) ) ) and nd nd a a an n n nc cr c ea ea ease in fr fr fre e equ ue u n nc n y of of of card d diac ac ac arr rr rrhy h h t t thm mi m a a (4 4 40.4% % % vs s s. 3 3 31.4 4 4%; %; %; P P P=0 0 0.0 0 05) ) ). A At 6 6 6-m m month th ths s s th he oxy y yge en gr g g oup p p had an increase in myo y y cardial infarct size on CMR (n ( ( =139; ; ; 20.3 g g grams vs. 13.1 gr g g ams; ; ; by guest on October 28, 2016 http://circ.ahajournals.org/ Downloaded from References: 5. S Sta ta tavi vi vits ts tsky ky ky Y, S Sh Shan n andl d dlin ing g g AH H H, El El Elle le lestad d d M M MH H H, H H Har r rt t t G G GB B, B V V Va an an N N Na atta a B B B, Me M Mess sse en e ge ge er r r JC JC JC, St tr ra raus uss s s M, M M t t De De Dekl kl klev e eva a a MN MN MN, Al Al Alex e exan an ande de der r r JM JM JM, Ma Ma Matt tt ttic ic ice e e M M M, C C Cla la lark rk rke e e D D D. Hy H Hype pe perb rb rbar ar aric ic ic o o oxyge ge gen n n an an and d d th th thro ro romb mb mbol ol olys s ysis is is i i in n n by guest on October 28, 2016
Oxygen therapy in ST-elevation myocardial infarction
European heart journal, 2018
To determine whether supplemental oxygen in patients with ST-elevation myocardial infarction (STEMI) impacts on procedure-related and clinical outcomes. 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 (...
Clinical Physiology and Functional Imaging, 2010
SummaryThe high mortality rate of cardiogenic shock in acute myocardial infarction (AMI) implies that debate over the correct haemodynamic management is still unresolved. The purpose of this review is to re‐evaluate the reciprocal relationships between oxygen‐related variables and response to treatment in a large number of patients with AMI. A MEDLINE search of reports published between 1970 and 2008 was performed. Twelve clinical reports including 453 patients with AMI and 989 sets of oxygen delivery and oxygen consumption expressed in ml min−1 m−2 and oxygen extraction ratio were selected. While processing this data, we found an early down‐regulation in oxygen demand linked to a decrease in oxygen supply. This mechanism is also supported in some studies by a critically low oxygen uptake that was not associated with lactic acidosis.
Blood-Gas and Hemodynamic Responses to Oxygen in Acute Myocardial Infarction
Circulation, 1973
Blood-gas (Pao2) and hemodynamic responses to the inhalation of oxygen were studied in 60 patients with acute myocardial infarction. Patients who were not in heart failure on admission and did not develop signs of heart failure with n the next 5 days achieved the same Pa02 level while breathing 100% oxygen as did patients without acute myocardial infarction. Patients with pulmonary edema or cardiogenic shock had a very poor Pa02 response to oxygen inhalation. Patients in mild heart failure at the time of study and patients who developed heart failure subsequent to the study had a Pao0 response intermeliate between the other two groups. This rise of Pa 02 with oxygen correlated with the cardiac index and right atrial oxygen prior to inhalation of oxygen. Uncomplicated patients responded to inhalation of oxygen with a decrease of heart rate, cardiac index, stroke index, and cardiac work, and an increase of peripheral resistance. Patients in pulmonary edema or cardiogenic shock or with a low cardiac index or low Pa02 responded with only a slight increase in peripheral resistance. The Pao0 achieved while breathing oxygen appeared to determine the type of hemodynamic response to oxygen. Administration of oxygen to patients with acute myocardial infarction is useful in identifying latent heart failure and in predicting the subsequent clinical course of these patients.
The effect of oxygen on the outcomes of non-ST-segment elevation acute coronary syndromes
IJC Metabolic & Endocrine, 2017
Background: This study aims to investigate the effect of oxygen in patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS) and those without hypoxia. Methods: In this clinical trial, the study population includes 72 patients (41 men and 31 women) aged 18 to 84 years old who were admitted to the emergency ward, diagnosed with NSTE-ACS, and had oxygen saturation level above 90% at the time of admission. By using the random sampling methods, the patients were divided into two groups: the intervention group (36) and the control group (36). In addition to the usual treatment in the first 6 h of admission to the emergency ward, the subjects in the intervention group received oxygen with nasal cannula at a rate of 4 to 6 l per minute, whereas the control group was given the same treatment with room air. Then we compared the incidence of some outcomes in the two groups. Results: The Mann-Whitney U test indicated no significant difference between the means of dysrhythmia (p = 0.141) during the first 24 h, troponin (p = 0.911), left ventricular ejection fraction (p = 0.419), frequency of angina (p = 0.214), and consumption of opioid analgesics (p = 0.297) during the second 24 h and duration of hospitalization (p = 0.887). Conclusion: The use of supplemental oxygen (FiO 2 : 40-45%) has no significant impact on clinical outcomes in patients with NSTE-ACS without hypoxia. Therefore, it is recommended that its routine use in patients without hypoxia be limited.