Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction
- PMID: 26002889
- DOI: 10.1161/CIRCULATIONAHA.114.014494
Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction
Abstract
Background: Oxygen is commonly administered to patients with ST-elevation-myocardial infarction despite previous studies suggesting a possible increase in myocardial injury as a result of coronary vasoconstriction and heightened oxidative stress.
Methods and results: We conducted a multicenter, prospective, randomized, controlled trial comparing oxygen (8 L/min) with no supplemental oxygen in patients with ST-elevation-myocardial infarction diagnosed on paramedic 12-lead ECG. Of 638 patients randomized, 441 patients had confirmed ST-elevation-myocardial infarction and underwent primary end-point analysis. The primary end point was myocardial infarct size as assessed by cardiac enzymes, troponin I, and creatine kinase. Secondary end points included recurrent myocardial infarction, cardiac arrhythmia, and myocardial infarct size assessed by cardiac magnetic resonance imaging at 6 months. Mean peak troponin was similar in the oxygen and no oxygen groups (57.4 versus 48.0 μg/L; ratio, 1.20; 95% confidence interval, 0.92-1.56; P=0.18). There was a significant increase in mean peak creatine kinase in the oxygen group compared with the no oxygen group (1948 versus 1543 U/L; means ratio, 1.27; 95% confidence interval, 1.04-1.52; P=0.01). There was an increase in the rate of recurrent myocardial infarction in the oxygen group compared with the no oxygen group (5.5% versus 0.9%; P=0.006) and an increase in frequency of cardiac arrhythmia (40.4% versus 31.4%; P=0.05). At 6 months, the oxygen group had an increase in myocardial infarct size on cardiac magnetic resonance (n=139; 20.3 versus 13.1 g; P=0.04).
Conclusion: Supplemental oxygen therapy in patients with ST-elevation-myocardial infarction but without hypoxia may increase early myocardial injury and was associated with larger myocardial infarct size assessed at 6 months.
Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01272713.
Keywords: ST-segment elevation myocardial infarction; myocardial infarction; oxygen.
© 2015 American Heart Association, Inc.
Comment in
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Oxygen for ST-Segment-Elevation Myocardial Infarction: Still Up in the Air.Circulation. 2015 Jun 16;131(24):2101-3. doi: 10.1161/CIRCULATIONAHA.115.017072. Epub 2015 May 22. Circulation. 2015. PMID: 26002888 No abstract available.
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Acute coronary syndromes: Should routine oxygen therapy be AVOIDed in normoxic patients with STEMI?Nat Rev Cardiol. 2015 Aug;12(8):444. doi: 10.1038/nrcardio.2015.94. Epub 2015 Jun 9. Nat Rev Cardiol. 2015. PMID: 26054830 No abstract available.
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[Infarction with ST segment elevation: room air versus oxygen?].Rev Med Suisse. 2015 Aug 26;11(483):1573. Rev Med Suisse. 2015. PMID: 26502591 French. No abstract available.
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Supplemental oxygen in patients without hypoxia in ST segment elevation myocardial infarction increases myocardial injury and infarct size.Evid Based Med. 2016 Feb;21(1):21. doi: 10.1136/ebmed-2015-110245. Epub 2015 Nov 6. Evid Based Med. 2016. PMID: 26546323 No abstract available.
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Letter by Bulluck and Hausenloy Regarding Article, "Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction".Circulation. 2016 Jan 19;133(3):e28. doi: 10.1161/CIRCULATIONAHA.115.017968. Circulation. 2016. PMID: 26783282 No abstract available.
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Response to Letter Regarding Article, "Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction".Circulation. 2016 Jan 19;133(3):e29. doi: 10.1161/CIRCULATIONAHA.115.019038. Circulation. 2016. PMID: 26783283 No abstract available.
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[Oxygen therapy in acute myocardial infarction].Med Klin Intensivmed Notfmed. 2017 Feb;112(1):50-52. doi: 10.1007/s00063-016-0224-2. Epub 2016 Oct 11. Med Klin Intensivmed Notfmed. 2017. PMID: 27730253 German. No abstract available.
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