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evident
Original paper
2017NEJMCardiology

DETO2X-AMI

Oxygen Therapy in Suspected Acute Myocardial Infarction

RCTAcute myocardial infarction

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Overview

Routine oxygen did not reduce 1-year mortality in suspected MI when baseline saturation was already 90% or higher.

Clinical takeaway

DETO2X-AMI ended routine oxygen for normoxic suspected MI; treat hypoxia, not the diagnosis of MI itself with oxygen.

Key result

1-year all-cause death was 5.0% with oxygen vs 5.1% with ambient air (HR 0.97).

Practice impact

Do not start supplemental oxygen for suspected MI if saturation is already at least 90%.

Evidence

Study design

Registry-based randomized clinical trial.

Enrollment

6,629

Follow-up

Death from any cause within 1 year after randomization.

Geography

Sweden

Clinical question

Does routine supplemental oxygen reduce 1-year mortality in suspected MI without baseline hypoxemia?

Population

  • Patients with suspected myocardial infarction and an oxygen saturation of 90% or higher.

Intervention

Supplemental oxygen 6 liters per minute for 6 to 12 hours, delivered through an open face mask.

Comparator

Ambient air.

Primary outcome

Death from any cause within 1 year after randomization.

Routine supplemental oxygen did not reduce 1-year all-cause mortality in suspected MI without baseline hypoxemia.

Hazard ratio / 0.97 / 95% CI 0.79-1.21 / p=0.80

Key results

  • 1-year all-cause death was 5.0% with oxygen vs 5.1% with ambient air; HR 0.97 (95% CI 0.79-1.21; P=0.80).
  • Rehospitalization with myocardial infarction within 1 year was 3.8% vs 3.3%; HR 1.13 (95% CI 0.88-1.46; P=0.33).
  • Hypoxemia developed in 1.9% of the oxygen group vs 7.7% of the ambient-air group.
  • Results were consistent across all predefined subgroups.

Harms

Not listed.

Clinical Use

Practice impact

  • Do not start supplemental oxygen for suspected MI if saturation is already at least 90%.

Applicability

  • Most applicable to patients with suspected myocardial infarction whose oxygen saturation is already 90% or higher.

Limitations

  • Registry-based randomization used nationwide Swedish registries for enrollment and data collection.
  • Patients with saturation below 90% were not the study population.
  • The oxygen dose was 6 liters per minute by open face mask for 6 to 12 hours.

Common misinterpretations

  • This is not permission to withhold oxygen from hypoxemic patients.
  • Similar 1-year death and rehospitalization for MI does not address every acute symptom endpoint.

Related evidence

ISIS-2 - Same Disease

Citation

Hofmann R, James SK, Jernberg T, et al. Oxygen Therapy in Suspected Acute Myocardial Infarction. N Engl J Med. 2017;377(13):1240-1249. doi:10.1056/NEJMoa1706222

Routine use of supplemental oxygen in patients with suspected myocardial infarction who did not have hypoxemia was not found to reduce 1-year all-cause mortality.