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Effect of oxygen therapy on myocardial salvage in ST elevation myocardial infarction: the randomized SOCCER trial

Khoshnood, Ardavana; Carlsson, Marcusb; Akbarzadeh, Mahina; Bhiladvala, Pallonjif; Roijer, Andersc; Nordlund, Davidb; Höglund, Peterd; Zughaft, Davidc; Todorova, Lizbete; Mokhtari, Arasha; Arheden, Håkanb; Erlinge, Davidc; Ekelund, Ulfa

European Journal of Emergency Medicine: April 2018 - Volume 25 - Issue 2 - p 78–84
doi: 10.1097/MEJ.0000000000000431
ORIGINAL ARTICLES

Objective Recent studies suggest that administration of O2 in patients with acute myocardial infarction may have negative effects. With the use of cardiac MRI (CMR), we evaluated the effects of supplemental O2 in patients with ST elevation myocardial infarction (STEMI) accepted for acute percutaneous coronary intervention (PCI).

Materials and methods This study was a randomized-controlled trial conducted at two university hospitals in Sweden. Normoxic STEMI patients were randomized in the ambulance to either supplemental O2 (10 l/min) or room air until the conclusion of the PCI. CMR was performed 2–6 days after the inclusion. The primary endpoint was the myocardial salvage index assessed by CMR. The secondary endpoints included infarct size and myocardium at risk.

Results At inclusion, the O2 (n=46) and air (n=49) patient groups had similar patient characteristics. There were no significant differences in myocardial salvage index [53.9±25.1 vs. 49.3±24.0%; 95% confidence interval (CI): −5.4 to 14.6], myocardium at risk (31.9±10.0% of the left ventricle in the O2 group vs. 30.0±11.8% in the air group; 95% CI: −2.6 to 6.3), or infarct size (15.6±10.4% of the left ventricle vs. 16.0±11.0%; 95% CI: −4.7 to 4.1).

Conclusion In STEMI patients undergoing acute PCI, we found no effect of high-flow oxygen compared with room air on the size of ischemia before PCI, myocardial salvage, or the resulting infarct size. These results support the safety of withholding supplemental oxygen in normoxic STEMI patients.

aDepartment of Emergency and Internal Medicine

bSection of Clinical Physiology, Clinical Sciences Lund, Skåne University Hospital, Lund University

cDepartment of Cardiology, Skåne University Hospital

dRegion Skåne Research and Development Centre

eRegion Skåne Prehospital Unit, Lund

fDepartment of Cardiology, Skåne University Hospital, Malmö, Sweden

Correspondence to Ardavan Khoshnood, MD, Department of Emergency and Internal Medicine, Skåne University Hospital, Klinikgatan 15, 221 85 Lund, Sweden Tel: +46 46 17 10 00; fax: +46 46 211 09 08; e-mail: ardavan.khoshnood@med.lu.se

Received July 26, 2016

Accepted October 10, 2016

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