Feature | ESC | September 07, 2017

Oxygen Therapy Does Not Improve Survival in Heart Attack Patients

Results of the DETO2X-AMI study show room air equal to oxygen in outcomes

Giving oxygen to patients suffering a heart attack is not beneficial, according to the DETO2X-AMI study.

September 7, 2017 — Oxygen therapy does not improve survival in patients with heart attack symptoms, according to late-breaking research from the DETO2X-AMI Study presented in a Hot Line session at the European Society of Cardiology (ESC) Congress and published in the New England Journal of Medicine (NEJM).

“The DETO2X-AMI study questions the current practice of routine oxygen therapy for all patients with suspected myocardial infarction,” said first author Dr Robin Hofmann, a cardiologist from the Karolinska Institutet at Södersjukhuset, Stockholm, Sweden.

This prospective, randomized, open-label trial enrolled 6,229 patients with suspected heart attack from 35 hospitals across Sweden. Half of the patients were assigned to oxygen given through an open face mask and the other half to room air without a mask.

The primary outcome, the mortality rate one year after randomization, was not statistically different between the two groups (5% in the oxygen group versus 5.1% in the air group). Similarly, there was no significant difference between the two groups for secondary endpoints, including the risk of a new heart attack or heart muscle injury measured by markers in the blood.

Even in patients at high risk, such as smokers, older patients, patients with diabetes, or patients with previous heart disease, the results were similar concerning mortality within one year.

European Society of Cardiology (ESC) guidelines on treatment of patients with ST-segment elevation myocardial infarction (STEMI) recommend oxygen (by mask or nasal prongs) for patients who are breathless, hypoxic, or have heart failure. They add that the systematic use of oxygen in patients without heart failure or dyspnoea (shortness of breath) “is at best uncertain”.

“ESC guidelines have gradually shifted towards more restrictive use of oxygen,” said author Prof. Stefan James, a cardiologist at Uppsala University, Uppsala, Sweden. “While the current recommendations were based on expert opinion only, we can now add substantial new data from our large clinical trial.”

“The study results will likely have an immediate impact on clinical practice and future guidelines,” he added. “Our findings do not support the routine use of oxygen therapy in all patients with symptoms of a heart attack. The general use of oxygen in these cases is still widespread in the world but can now be adjusted.”

A fear that oxygen therapy could be harmful arose after the AVOID trial found a larger infarct size in patients receiving oxygen therapy. “Routine oxygen therapy seems unnecessary in this patient group, but fortunately our data do not give any indication of increased risk for the patients on oxygen,” said Prof. James. “So all of us who have generally used oxygen for decades can now rest assured.”

The DETO2X-AMI trial is the first large-scale randomized trial of oxygen therapy in patients with suspected myocardial infarction to be large enough to reveal meaningful findings on mortality and morbidity. The study enrolled six times more patients than all previous randomized trials of this therapy combined and included a much broader range of patients to make the results relevant to everyday clinical practice.

The study’s registry-based randomized clinical trial protocol used national registries including SWEDEHEART for randomization, case record forms and follow-up. Dr Hofmann said: “With this design we could enrol 6 629 patients with high quality data in less than three years and keep overall costs to a fraction of a conventional randomized trial.”

Read about other late-breakers in the article “Late-breaking Trial Presentations at ESC 2017.”
 

References:

1. Robin Hofmann, Stefan K. James, Tomas Jernberg, et al. “Oxygen Therapy in Suspected Acute Myocardial Infarction.” NEJM. Published online Aug. 28, 2017.

2. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2012;33:2569–2619. doi:10.1093/eurheartj/ehs215.

3. Stub D, et al. Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation. 2015;131:2143–2150. doi: 10.1161/CIRCULATIONAHA.114.014494.

Related Content

News | Cath Lab

May 26, 2022 — The U.S. Food and Drug Administration (FDA) has recalled the Dragonfly OpStar Imaging Catheter, and has ...

Home May 26, 2022
Home
News | Cath Lab
April 25, 2022 – NewYork-Presbyterian Hudson Valley Hospital celebrated the launch of its interventional cardiology ...
Home April 25, 2022
Home
News | Cath Lab
April 18, 2022 – Royal Philips and Oulu University Hospital (Finland) have announced a strategic 10-year partnership ...
Home April 18, 2022
Home
News | Cath Lab
February 16, 2022 – Fremont Bank Foundation recently donated $750,000 to its community partner, St. Rose Hospital ...
Home February 16, 2022
Home
News | Cath Lab
February 14, 2022 — A collaborative effort between The Valley Heart and Vascular Institute’s cardiology team ...
Home February 14, 2022
Home
Sponsored Content | Videos | Cath Lab

Advancements in analytics and data visualizations are helping to streamline operations and improve productivity at cath ...

Home January 13, 2022
Home
News | Cath Lab

January 4, 2022 — The U.S. Food and Drug Administration (FDA) has authorized marketing of the first laser-based device ...

Home January 04, 2022
Home
News | Cath Lab

December 14, 2021 — RSIP Vision, a medical imaging company applying advanced artificial intelligence (AI) and computer ...

Home December 14, 2021
Home
Feature | Cath Lab

November 15, 2021 — RealView Imaging Ltd. recently received FDA 510(k) clearance for its Holoscope-i holographic system ...

Home November 15, 2021
Home
News | Cath Lab

November 10, 2021 — Shockwave Medical a pioneer in the development of Intravascular Lithotripsy (IVL) to treat severely ...

Home November 10, 2021
Home
Subscribe Now