Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation.
Aged
Aged, 80 and over
Biomarkers
/ blood
Female
Heart Failure
/ blood
Hospital Mortality
Humans
Hypoxia
/ blood
Male
Middle Aged
Myocardial Infarction
/ blood
Oxygen
/ administration & dosage
Oxygen Inhalation Therapy
/ adverse effects
Patient Readmission
Registries
Risk Factors
Sweden
Time Factors
Treatment Outcome
cardiovascular outcomes
myocardial infarction
oxygen therapy
randomized clinical trial
reactive oxygen species
Journal
JACC. Cardiovascular interventions
ISSN: 1876-7605
Titre abrégé: JACC Cardiovasc Interv
Pays: United States
ID NLM: 101467004
Informations de publication
Date de publication:
24 02 2020
24 02 2020
Historique:
received:
19
06
2019
revised:
13
08
2019
accepted:
04
09
2019
pubmed:
16
12
2019
medline:
21
10
2020
entrez:
16
12
2019
Statut:
ppublish
Résumé
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. 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. 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. 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). 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).
Sections du résumé
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).
Identifiants
pubmed: 31838113
pii: S1936-8798(19)31940-5
doi: 10.1016/j.jcin.2019.09.016
pii:
doi:
Substances chimiques
Biomarkers
0
Oxygen
S88TT14065
Banques de données
ClinicalTrials.gov
['NCT01787110']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
502-513Investigateurs
Leif Svensson
(L)
Johan Herlitz
(J)
Robin Hofmann
(R)
Nils Witt
(N)
Mats Frick
(M)
Tomas Jernberg
(T)
Mattias Ekström
(M)
Rickard Linder
(R)
Lennart Nilsson
(L)
Joakim Alfredsson
(J)
David Erlinge
(D)
David Zughaft
(D)
Ulf Ekelund
(U)
Annica Ravn-Fischer
(A)
Elmir Omerovic
(E)
Thomas Kellerth
(T)
Stefan James
(S)
Bertil Lindahl
(B)
Ollie Östlund
(O)
Leif Svensson
(L)
Johan Herlitz
(J)
Robin Hofmann
(R)
Nils Witt
(N)
David Erlinge
(D)
Tomas Jernberg
(T)
Bertil Lindahl
(B)
Stefan James
(S)
Eva Jacobsson
(E)
Ollie Östlund
(O)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.