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Effect of supersaturated oxygen delivery on infarct size after percutaneous coronary intervention in acute myocardial infarction.

Publication ,  Journal Article
Stone, GW; Martin, JL; de Boer, M-J; Margheri, M; Bramucci, E; Blankenship, JC; Metzger, DC; Gibbons, RJ; Lindsay, BS; Weiner, BH; Lansky, AJ ...
Published in: Circ Cardiovasc Interv
October 2009

BACKGROUND: Myocardial salvage is often suboptimal after percutaneous coronary intervention in ST-segment elevation myocardial infarction. Posthoc subgroup analysis from a previous trial (AMIHOT I) suggested that intracoronary delivery of supersaturated oxygen (SSO(2)) may reduce infarct size in patients with large ST-segment elevation myocardial infarction treated early. METHODS AND RESULTS: A prospective, multicenter trial was performed in which 301 patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset were randomized to a 90-minute intracoronary SSO(2) infusion in the left anterior descending artery infarct territory (n=222) or control (n=79). The primary efficacy measure was infarct size in the intention-to-treat population (powered for superiority), and the primary safety measure was composite major adverse cardiovascular events at 30 days in the intention-to-treat and per-protocol populations (powered for noninferiority), with Bayesian hierarchical modeling used to allow partial pooling of evidence from AMIHOT I. Among 281 randomized patients with tc-99m-sestamibi single-photon emission computed tomography data in AMIHOT II, median (interquartile range) infarct size was 26.5% (8.5%, 44%) with control compared with 20% (6%, 37%) after SSO(2). The pooled adjusted infarct size was 25% (7%, 42%) with control compared with 18.5% (3.5%, 34.5%) after SSO(2) (P(Wilcoxon)=0.02; Bayesian posterior probability of superiority, 96.9%). The Bayesian pooled 30-day mean (+/-SE) rates of major adverse cardiovascular events were 5.0+/-1.4% for control and 5.9+/-1.4% for SSO(2) by intention-to-treat, and 5.1+/-1.5% for control and 4.7+/-1.5% for SSO(2) by per-protocol analysis (posterior probability of noninferiority, 99.5% and 99.9%, respectively). CONCLUSIONS: Among patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset, infusion of SSO(2) into the left anterior descending artery infarct territory results in a significant reduction in infarct size with noninferior rates of major adverse cardiovascular events at 30 days. Clinical Trial Registration- clinicaltrials.gov Identifier: NCT00175058.

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Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

October 2009

Volume

2

Issue

5

Start / End Page

366 / 375

Location

United States

Related Subject Headings

  • Troponin
  • Treatment Outcome
  • Time Factors
  • Prospective Studies
  • Oxygen
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

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Stone, G. W., Martin, J. L., de Boer, M.-J., Margheri, M., Bramucci, E., Blankenship, J. C., … AMIHOT-II Trial Investigators, . (2009). Effect of supersaturated oxygen delivery on infarct size after percutaneous coronary intervention in acute myocardial infarction. Circ Cardiovasc Interv, 2(5), 366–375. https://doi.org/10.1161/CIRCINTERVENTIONS.108.840066
Stone, Gregg W., Jack L. Martin, Menko-Jan de Boer, Massimo Margheri, Ezio Bramucci, James C. Blankenship, D Christopher Metzger, et al. “Effect of supersaturated oxygen delivery on infarct size after percutaneous coronary intervention in acute myocardial infarction.Circ Cardiovasc Interv 2, no. 5 (October 2009): 366–75. https://doi.org/10.1161/CIRCINTERVENTIONS.108.840066.
Stone GW, Martin JL, de Boer M-J, Margheri M, Bramucci E, Blankenship JC, et al. Effect of supersaturated oxygen delivery on infarct size after percutaneous coronary intervention in acute myocardial infarction. Circ Cardiovasc Interv. 2009 Oct;2(5):366–75.
Stone, Gregg W., et al. “Effect of supersaturated oxygen delivery on infarct size after percutaneous coronary intervention in acute myocardial infarction.Circ Cardiovasc Interv, vol. 2, no. 5, Oct. 2009, pp. 366–75. Pubmed, doi:10.1161/CIRCINTERVENTIONS.108.840066.
Stone GW, Martin JL, de Boer M-J, Margheri M, Bramucci E, Blankenship JC, Metzger DC, Gibbons RJ, Lindsay BS, Weiner BH, Lansky AJ, Krucoff MW, Fahy M, Boscardin WJ, AMIHOT-II Trial Investigators. Effect of supersaturated oxygen delivery on infarct size after percutaneous coronary intervention in acute myocardial infarction. Circ Cardiovasc Interv. 2009 Oct;2(5):366–375.

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

October 2009

Volume

2

Issue

5

Start / End Page

366 / 375

Location

United States

Related Subject Headings

  • Troponin
  • Treatment Outcome
  • Time Factors
  • Prospective Studies
  • Oxygen
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female