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Oxygen therapy in ST-elevation myocardial infarction.
Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet.
Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet.
Cardiology, Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset.
Cardiology, Department of Clinical Sciences, Karolinska Institutet.
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 29, p. 2730-2739Article in journal (Refereed) Published
Abstract [en]

Aims: To determine whether supplemental oxygen in patients with ST-elevation myocardial infarction (STEMI) impacts on procedure-related and clinical outcomes.

Methods and results: 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 (HR 0.86, 95% CI 0.61-1.22; P = 0.41), rate of rehospitalization for MI (HR 0.92, 95% CI 0.57-1.48; P = 0.73), rehospitalization for cardiogenic shock (HR 1.05, 95% CI 0.21-5.22; P = 0.95), or stent thrombosis (HR 1.27, 95% CI 0.46-3.51; P = 0.64). The primary composite endpoint was consistent across all subgroups, as well as at different time points, such as during hospital stay, at 30 days and the total duration of follow-up up to 1356 days.

Conclusions: Routine use of supplemental oxygen in normoxemic patients with STEMI undergoing primary PCI did not significantly affect 1-year all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis.

Place, publisher, year, edition, pages
2018. Vol. 39, no 29, p. 2730-2739
Keywords [en]
Oxygen, Percutaneous coronary intervention, Reactive oxygen species, Registry-based randomized clinical trial, Reperfusion injury, ST-elevation myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-15535DOI: 10.1093/eurheartj/ehy326ISI: 000441009100012PubMedID: 29912429Scopus ID: 2-s2.0-85054427072OAI: oai:DiVA.org:hb-15535DiVA, id: diva2:1273251
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2019-01-14Bibliographically approved

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