Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, Stockholm, Sweden.
Cardiology, Department of Medical Sciences, Uppsala University, Akademiska sjukhuset, Entrance 40, floor 5, Uppsala, Sweden.
Eur Heart J. 2018 Aug 1;39(29):2730-2739. doi: 10.1093/eurheartj/ehy326.
To determine whether supplemental oxygen in patients with ST-elevation myocardial infarction (STEMI) impacts on procedure-related and clinical outcomes.
The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized patients with suspected myocardial infarction (MI) to receive oxygen at 6 L/min for 6-12 h or ambient air. In this pre-specified analysis, we included only STEMI patients who underwent percutaneous coronary intervention (PCI). In total, 2807 patients were included, 1361 assigned to receive oxygen, and 1446 assigned to ambient air. The pre-specified primary composite endpoint of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year occurred in 6.3% (86 of 1361) of patients allocated to oxygen compared to 7.5% (108 of 1446) allocated to ambient air [hazard ratio (HR) 0.85, 95% confidence interval (95% 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 1356 days.
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.
确定 ST 段抬高型心肌梗死（STEMI）患者吸氧是否会影响与治疗相关和临床结局。
DETO2X-AMI 试验旨在确定氧在疑似急性心肌梗死（DETO2X-AMI）中的作用，将疑似心肌梗死（MI）患者随机分为接受 6L/min 吸氧 6-12 小时或环境空气组。在此预先指定的分析中，我们仅纳入接受经皮冠状动脉介入治疗（PCI）的 STEMI 患者。共纳入 2807 例患者，其中 1361 例接受吸氧治疗，1446 例接受环境空气治疗。1 年时全因死亡、因 MI 再次住院、心源性休克或支架血栓形成的预先指定的主要复合终点在接受吸氧治疗的患者中发生率为 6.3%（86/1361），而接受环境空气治疗的患者中发生率为 7.5%（108/1446）[风险比（HR）0.85，95%置信区间（95%CI）0.64-1.13；P=0.27]。任何原因导致的死亡率（HR 0.86，95%CI 0.61-1.22；P=0.41）、因 MI 再次住院的发生率（HR 0.92，95%CI 0.57-1.48；P=0.73）、心源性休克再住院率（HR 1.05，95%CI 0.21-5.22；P=0.95）或支架血栓形成率（HR 1.27，95%CI 0.46-3.51；P=0.64）均无差异。主要复合终点在所有亚组中一致，在不同时间点（如住院期间、30 天和总随访时间 1356 天）也一致。
在接受直接 PCI 的 STEMI 患者中常规使用吸氧并不会显著影响 1 年时的全因死亡、因 MI 再次住院、心源性休克或支架血栓形成。
