Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation

Research output: Contribution to journalArticle


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)


  • Stefan K. James
  • David Erlinge
  • Johan Herlitz
  • Joakim Alfredsson
  • Sasha Koul
  • Ole Fröbert
  • Thomas Kellerth
  • Annica Ravn-Fischer
  • Patrik Alström
  • Ollie Östlund
  • Tomas Jernberg
  • Bertil Lindahl
  • Robin Hofmann
  • DETO2X-SWEDEHEART Investigators
  • Ulf Ekelund (Contributor)
External organisations
  • Uppsala University
  • University of Borås
  • Linköping University
  • Örebro University
  • Sahlgrenska University Hospital
  • Karolinska Institutet
  • Danderyd Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • cardiovascular outcomes, myocardial infarction, oxygen therapy, randomized clinical trial, reactive oxygen species
Original languageEnglish
Pages (from-to)502-513
Number of pages12
JournalJACC: Cardiovascular Interventions
Issue number4
Publication statusPublished - 2020 Feb 24
Publication categoryResearch