DETO2X-AMI: Supplemental Oxygen Therapy in Acute MI Patients Without Hypoxemia
Routine oxygen therapy in patients with suspected acute myocardial infarction (MI) who do not have hypoxemia at baseline did not appear to have a beneficial effect on all-cause mortality at one year, based on data from the DETO2X-AMI trial presented at ESC Congress 2017 in Barcelona. The findings were simultaneously published in the New England Journal of Medicine.
Nationwide Swedish registries were used to enroll and collect data on 6,629 patients with suspected MI and an oxygen saturation of 90 percent or higher. Patients were randomly assigned to receive either supplemental oxygen (six liters per minute for six to 12 hours via an open face mask) or ambient air. The primary endpoint was death from any cause within one year after randomization.
Overall results found the median duration of oxygen therapy was 11.6 hours and the median oxygen saturation at the end of the treatment period was 99 percent among patients assigned to oxygen and 97 percent among patients assigned to ambient air. Hypoxemia developed in 1.9 percent of patients (62) in the oxygen group, compared with 7.7 percent of patients (254) in the ambient air group. The primary endpoint occurred in 5.0 percent of patients (166 out of 3,311) in the oxygen group and in 5.1 percent of patients (168 out of 3,318) in the ambient air group. Within one year, 3.8 percent of patients (126) in the oxygen group and 3.3 percent of patients (111) in the ambient air group were re-hospitalized with MI.
In a related editorial, Joseph Loscalzo, MD, PhD, FACC, writes that the DETO2X-AMI “provides definitive evidence for a lack of benefit of supplemental oxygen therapy in patients with acute MI who have normal oxygen saturation.” He goes on to say that “it is clearly time for clinical practice to change to reflect this definitive evidence.”
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