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Oxygen Therapy in STEMI Patients
Study Questions:
What is the impact of supplemental oxygen in patients with ST-segment elevation myocardial infarction (STEMI) on procedure-related and clinical outcomes?
Methods:
The DETO2X-SWEDEHEART investigators randomized patients with suspected myocardial infarction (MI) to receive oxygen at 6 L/min for 6-12 hours or ambient air. In this prespecified analysis, they included 2,807 STEMI patients who underwent percutaneous coronary intervention (PCI). For this study, the prespecified primary endpoint was a composite of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year (major adverse cardiac event [MACE1]). The secondary endpoint was a composite of MACE1 and target vessel revascularization (MACE2). Time to event within 365 days and the entire follow-up is presented in the Kaplan–Meier curves. Hazard ratios (HRs) between treatment groups were calculated using a Cox proportional hazard model, adjusted for age in years (as a linear covariate on the log-hazard scale) and sex.
Results:
In total, 2,807 patients were included, 1,361 were assigned to receive oxygen, and 1,446 were assigned to ambient air. The prespecified primary composite endpoint of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year occurred in 6.3% (86 of 1,361) of patients allocated to oxygen compared to 7.5% (108 of 1,446) allocated to ambient air (HR, 0.85; 95% confidence interval [CI], 0.64-1.13; p = 0.27). There was no difference in the rate of death from any cause (HR, 0.86; 95% CI, 0.61-1.22; p = 0.41), rate of rehospitalization for MI (HR, 0.92; 95% CI, 0.57-1.48; p = 0.73), rehospitalization for cardiogenic shock (HR, 1.05; 95% CI, 0.21-5.22; p = 0.95), or stent thrombosis (HR, 1.27; 95% CI, 0.46-3.51; p = 0.64). The primary composite endpoint was consistent across all subgroups, as well as at different time points, such as during hospital stay, at 30 days, and the total duration of follow-up up to 1,356 days.
Conclusions:
The authors concluded that routine use of supplemental oxygen in normoxemic patients with STEMI undergoing primary PCI did not significantly affect 1-year all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis.
Perspective:
This prespecified subgroup analysis of the DETO2X-AMI trial reports that among patients with STEMI undergoing primary PCI, oxygen therapy did not reduce the rate of the composite of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year, at short-term or through the entire follow-up of the trial. It appears reasonable and safe to withhold oxygen therapy in STEMI patients without hypoxemia at baseline, which is consistent with current guidelines. However, frequent monitoring is recommended, as a subgroup of patients will develop hypoxemia and would be candidates for supplemental oxygen therapy.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and ACS
Keywords: Acute Coronary Syndrome, Hypoxia, Brain, Myocardial Infarction, Myocardial Revascularization, Oxygen, Oxygen Inhalation Therapy, Percutaneous Coronary Intervention, Secondary Prevention, Shock, Cardiogenic, Stents, Thrombosis
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