Stefan K James1, David Erlinge2, Johan Herlitz3, Joakim Alfredsson4, Sasha Koul2, Ole Fröbert5, Thomas Kellerth5, Annica Ravn-Fischer6, Patrik Alström7, Ollie Östlund8, Tomas Jernberg9, Bertil Lindahl1, Robin Hofmann10. 1. Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 2. Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden. 3. Department of Health Sciences, University of Borås, Borås, Sweden. 4. Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping, Sweden. 5. Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 6. Department of Molecular and Clinical Medicine and Sahlgrenska University Hospital, Department of Cardiology, University of Gothenburg, Gothenburg, Sweden. 7. Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden. 8. Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 9. Department of Clinical Sciences, Cardiology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. 10. Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden. Electronic address: robin.hofmann@sll.se.
Abstract
OBJECTIVES: The aim of this study was to determine the effect of supplemental oxygen in patients with myocardial infarction (MI) on the composite of all-cause death, rehospitalization with MI, or heart failure related to baseline oxygen saturation. A secondary objective was to investigate outcomes in patients developing hypoxemia. BACKGROUND: In the DETO2X-AMI (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 l/min for 6 to 12 h or ambient air. METHODS: The study population of 5,010 patients with confirmed MI was divided by baseline oxygen saturation into a low-normal (90% to 94%) and a high-normal (95% to 100%) cohort. Outcomes are reported within 1 year. To increase power, all follow-up time (between 1 and 4 years) was included post hoc, and interaction analyses were performed with oxygen saturation as a continuous covariate. RESULTS: The composite endpoint of all-cause death, rehospitalization with MI, or heart failure occurred significantly more often in patients in the low-normal cohort (17.3%) compared with those in the high-normal cohort (9.5%) (p < 0.001), and most often in patients developing hypoxemia (23.6%). Oxygen therapy compared with ambient air was not associated with improved outcomes regardless of baseline oxygen saturation (interaction p values: composite endpoint, p = 0.79; all-cause death, p = 0.33; rehospitalization with MI, p = 0.86; hospitalization for heart failure, p = 0.35). CONCLUSIONS: Irrespective of oxygen saturation at baseline, we found no clinically relevant beneficial effect of routine oxygen therapy in normoxemic patients with MI regarding cardiovascular outcomes. Low-normal baseline oxygen saturation or development of hypoxemia was identified as an independent marker of poor prognosis. (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction; NCT01787110).
RCT Entities:
OBJECTIVES: The aim of this study was to determine the effect of supplemental oxygen in patients with myocardial infarction (MI) on the composite of all-cause death, rehospitalization with MI, or heart failure related to baseline oxygen saturation. A secondary objective was to investigate outcomes in patients developing hypoxemia. BACKGROUND: In the DETO2X-AMI (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 l/min for 6 to 12 h or ambient air. METHODS: The study population of 5,010 patients with confirmed MI was divided by baseline oxygen saturation into a low-normal (90% to 94%) and a high-normal (95% to 100%) cohort. Outcomes are reported within 1 year. To increase power, all follow-up time (between 1 and 4 years) was included post hoc, and interaction analyses were performed with oxygen saturation as a continuous covariate. RESULTS: The composite endpoint of all-cause death, rehospitalization with MI, or heart failure occurred significantly more often in patients in the low-normal cohort (17.3%) compared with those in the high-normal cohort (9.5%) (p < 0.001), and most often in patients developing hypoxemia (23.6%). Oxygen therapy compared with ambient air was not associated with improved outcomes regardless of baseline oxygen saturation (interaction p values: composite endpoint, p = 0.79; all-cause death, p = 0.33; rehospitalization with MI, p = 0.86; hospitalization for heart failure, p = 0.35). CONCLUSIONS: Irrespective of oxygen saturation at baseline, we found no clinically relevant beneficial effect of routine oxygen therapy in normoxemic patients with MI regarding cardiovascular outcomes. Low-normal baseline oxygen saturation or development of hypoxemia was identified as an independent marker of poor prognosis. (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction; NCT01787110).
Authors: Yue Yu; Jun Wang; Qing Wang; Junnan Wang; Jie Min; Suyu Wang; Pei Wang; Renhong Huang; Jian Xiao; Yufeng Zhang; Zhinong Wang Journal: Ann Transl Med Date: 2020-11
Authors: Robin Hofmann; Tamrat Befekadu Abebe; Johan Herlitz; Stefan K James; David Erlinge; Troels Yndigegn; Joakim Alfredsson; Thomas Kellerth; Annica Ravn-Fischer; Sebastian Völz; Jörg Lauermann; Tomas Jernberg; Bertil Lindahl; Sophie Langenskiöld Journal: Front Cardiovasc Med Date: 2021-03-15
Authors: Robin Hofmann; Tamrat Befekadu Abebe; Johan Herlitz; Stefan K James; David Erlinge; Joakim Alfredsson; Tomas Jernberg; Thomas Kellerth; Annica Ravn-Fischer; Bertil Lindahl; Sophie Langenskiöld Journal: Front Public Health Date: 2022-01-12
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