Grand Rounds

Does Oxygen Therapy Really Help During a Suspected Heart Attack?

BACKGROUND AND PURPOSE:

Oxygen has been a mainstay of treatment for myocardial infarction for decades, whether or not hypoxemia is present
- Data is limited as to whether there is any benefit
Hofmann et al. (NEJM, 2017) report on the Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction (DETO2X-AMI) trial that looked at the effect of oxygen therapy in the setting of suspected myocardial infarction without hypoxemia

Multicenter, parallel-group, open-label, registry-based, randomized, controlled trial
Subjects were categorized into the following groups
- Supplemental oxygen: 6 L/min for 6 -12 hours, delivered through face mask
- Ambient air
Primary outcome
- All-cause mortality at 1 year
Secondary outcomes were
- Death from any cause within 30 days after randomization
- Rehospitalization with myocardial infarction
- Rehospitalization with heart failure
- Cardiovascular death
- Composites of the above at 30 days and 365 days

6629 patients enrolled with suspected myocardial infarction
- 31.6% women in the oxygen arm and 29.4% in the ambient arm
Hypoxemia developed in 62 (1.9%) in oxygen group and 254 (7.7%) in ambient group
The median of highest troponin level during hospitalization was 946.5 ng/L in oxygen group and 983.0 ng/L in ambient-air group
Mortality within 1 year occurred in 5.0% of patients in oxygen group and 5.1% in ambient air group
Rehospitalization occurred in 126 (3.8%) in oxygen group and 111 (3.3%) in ambient air group

There was no significant difference in mortality rate between groups that received supplemental air and ambient air
No significant difference was seen in number of rehospitalizations between study groups
Supplemental oxygen does not offer any benefit to patients with acute myocardial infarction without hypoxemia

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