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.

Giving oxygen to patients suffering a heart attack is not beneficial, according to the DETO2X-AMI study presented at ESC 2017.

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

MRI May Predict Neurological Outcomes for Cardiac Arrest Survivors
News | Sudden Cardiac Arrest| October 18, 2017
Magnetic resonance imaging (MRI)-based measurements of the functional connections in the brain can help predict long-...
Xarelto Significantly Reduces Major Cardioavascular Events in Stable CAD and PAD Patients
News | Pharmaceuticals| October 18, 2017
October 18, 2017 — Results from the pivotal Phase 3 COMPASS study found that the...
Baylis Medical and Siemens Co-Sponsor Transseptal Access Training Course
News | EP Lab| October 18, 2017
Baylis Medical Co. Inc. and Siemens Healthineers are co-sponsoring a first-of-its kind training program aimed at...
Societies Issue New Performance and Quality Measures for Treating Patients with Heart Attack
News | Cath Lab| October 17, 2017
The American College of Cardiology and the American Heart Association recently released updated clinical performance...
First Patient Enrolled in U.S. Arm of ALIVE Pivotal Heart Failure Trial
News | Heart Failure| October 17, 2017
October 17, 2017 — BioVentrix Inc. recently announced enrollment of the first patient in the U.S.
Dee Dee Wang runs Henry Ford Hospital's 3D printing lab for its complex structural heart cardiology program.

Dee Dee Wang, M.D., runs Henry Ford Hospital's 3-D printing lab that supports its complex structural heart program.

Feature | 3-D Printing| October 13, 2017 | Dave Fornell
Three-dimensional (3-D) printed anatomic models created from a patient’s computed tomography (CT), magnetic resonance...
Low Mortality and Stroke Risks Displayed for Minimally Invasive Aortic Valve Replacements
News | Heart Valve Technology| October 11, 2017
An analysis of more than 1,000 minimally invasive aortic valve replacements and more than 400 additional associated...
New Evaluation Sends Low-Risk ER Chest Pain Patients Home Sooner
News | Cardiac Diagnostics| October 10, 2017
A new evaluation to determine whether emergency room patients with chest pain can go home and follow up with their...
Videos | Chronic Total Occlusion (CTO)| October 09, 2017
Bill Lombardi, M.D., director of complex coronary artery interventions at the University of Washington, discusses the
BTG Acquires Roxwood Medical
News | Business| October 05, 2017
BTG plc announced it has acquired Roxwood Medical, provider of advanced cardiovascular specialty catheters used in the...
Overlay Init