Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction - DETO2X-AMI

Contribution To Literature:

The DETO2X-AMI trial showed that supplemental oxygen therapy was not beneficial at improving survival.

Description:

The goal of the trial was to evaluate supplemental oxygen therapy compared with ambient air among patients with suspected acute myocardial infarction (AMI).

Study Design

  • Randomized
  • Parallel

Patients with chest pain symptoms were randomized to supplemental oxygen therapy (n = 3,311) vs. ambient air (n = 3,318).

  • Total number of enrollees: 6,629
  • Duration of follow-up: 12 months
  • Mean patient age: 68 years
  • Percentage female: 32%
  • Percentage with diabetes: 18%
  • Median duration of oxygen therapy: 11.6 hours.

Inclusion criteria:

  • Patients ≥30 years of age admitted with suspected AMI
  • Oxygen saturation ≥90%
  • Electrocardiogram changes or elevated cardiac enzymes

Exclusion criteria:

  • Patients requiring supplemental oxygen therapy
  • Cardiac arrest

Principal Findings:

The primary outcome, incidence of all-cause mortality at 12 months, occurred in 5.0% of the oxygen group vs. 5.1% of the ambient air group (p = 0.81). The results were consistent among all tested subgroups.

Secondary outcomes:

  • Rehospitalization for MI: 3.8% of the oxygen group vs. 3.3% of the ambient air group (p = 0.33)
  • Peak level of pain: 4.0 for oxygen vs. 3.0 for ambient air (p = 0.74)
  • Death or hospitalization for heart failure at 2.1 years: 11.2% for oxygen vs. 10.8% for ambient air (p = 0.84)

Interpretation:

Among patients with suspected MI, supplemental oxygen therapy was not beneficial. Oxygen therapy compared with ambient air did not improve survival. Oxygen also failed to improve pain. Findings were the same among all subgroups. The results of this trial are consistent with the smaller AVOID trial. The routine use of oxygen therapy among patients with suspected MI who are not hypoxic cannot be recommended.

References:

Hofmann R, Jenberg T, Lindahl B, et al., on behalf of the DETO2X-SWEDEHEART Investigators. Long-Term Effects of Oxygen Therapy on Death or Hospitalization for Heart Failure in Patients With Suspected Acute Myocardial Infarction. Circulation 2018;Aug 27:[Epub ahead of print].

Presented by Dr. Tomas Jernberg at the European Society of Cardiology Congress, Munich, Germany, August 27, 2018.

Sparv D, Hofmann R, Gunnarsson A, et al., on behalf of the DETO2X-SWEDEHEART Investigators. The Analgesic Effect of Oxygen in Suspected Acute Myocardial Infarction: A Substudy of the DETO2X-AMI Trial. JACC Cardiovasc Interv 2018;11:1590-7.

Hofmann R, James SK, Jernberg T, et al. Oxygen Therapy in Suspected Acute Myocardial Infarction. N Engl J Med 2017;377:1240-9.

Editorial: Is Oxygen Therapy Beneficial in Acute Myocardial Infarction? Simple Question, Loscalzo J. Complicated Mechanism, Simple Answer. N Engl J Med 2017;377:1286-7.

Presented by Dr. Robin Hofmann at the European Society of Cardiology Congress, Barcelona, Spain, August 28, 2017.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Acute Heart Failure

Keywords: ESC Congress, ESC18, ESC2017, Acute Coronary Syndrome, Chest Pain, Electrocardiography, Heart Failure, Hypoxia-Ischemia, Brain, Myocardial Infarction, Oxygen Inhalation Therapy, Primary Prevention, Survival


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