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Clinical Summary

COPD patients with suspected AMI: extra O2 has no effect

Takeaway

  • Among normoxemic COPD patients with suspected acute myocardial infarction (AMI), supplemental oxygen therapy does not appear to affect 1-year outcomes.

Why this matters

  • For all normoxemic comers with suspected AMI, DETO2X-AMI found no benefit to 1-year outcomes of oxygen therapy vs room air.
  • COPD can alter patient response to oxygen.

Key results

  • Patients with COPD vs without:
    • All-cause mortality: 10.8% vs 4.8%.
    • Cardiovascular mortality: 6.1% vs 3.5%.
    • Rehospitalization for AMI or death: 15.5% vs 7.8%.
    • Hospitalization for heart failure (HF) or death: 15.9% vs 10.57%.
  • COPD cohort, oxygen therapy vs room air (HRs; 95% CIs):
    • All-cause mortality: 0.99 (0.50-1.99; Pinteraction=.96);
    • Cardiovascular mortality: 0.80 (0.32-2.04; Pinteraction=.59);
    • Rehospitalization for AMI or death: 1.27 (0.71-2.28; Pinteraction=.46); and
    • Hospitalization for HF or death: 1.08 (0.61-1.91; Pinteraction=.77).

Study design

  • Prespecified subgroup analysis of DETO2X-AMI, which randomly assigned patients with suspected AMI to oxygen therapy vs room air (n=6629).
  • Researchers compared oxygen vs room air in subset with COPD (n=155 and 141, respectively).
  • Outcome: 1-year all-cause mortality.
  • Funding: Swedish Research Council, Swedish Heart-Lung Foundation.

Limitations

  • Few patients with COPD, few events, wide confidence intervals.
  • COPD severities unknown.
  • May not generalize to hypoxemic patients.

References


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