Oxygen therapy in suspected acute myocardial infarction

Research output: Contribution to journalArticle

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.)

Details

Authors
  • Robin Hofmann
  • Stefan K. James
  • Tomas Jernberg
  • Bertil Lindahl
  • David Erlinge
  • Nils Witt
  • Gabriel Arefalk
  • Mats Frick
  • Joakim Alfredsson
  • Lennart Nilsson
  • Annica RavnFischer
  • 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
Organisations
External organisations
  • Karolinska Institutet
  • Uppsala University
  • Uppsala University Hospital
  • Danderyd Hospital
  • Linköping University
  • Sahlgrenska University Hospital
  • Örebro University Hospital
  • Ryhov County Hospital, Jönköping
  • Karlstad Hospital
  • Karolinska University Hospital
  • University of Borås
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
Original languageEnglish
Pages (from-to)1240-1249
JournalNew England Journal of Medicine
Volume377
Issue number13
StatePublished - 2017 Sep 28
Publication categoryResearch
Peer-reviewedYes

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