|
1. HBO improved myocardial contractility on echo
and was associated with a lower cardiac enzyme peak. |
Citation/s:
1. Dekleva M, Neskovic A, Vlahovic A, Putnikovic B, Beleslin B, Ostojic M.
Adjunctive effect of hyperbaric oxygen treatment after thrombolysis on left
ventricular function in patients with acute myocardial infarction. American
Heart Journal 2004; 148(4):E14 [same study as Vlahovic et al 2004]
Lead author's name and fax: Dekleva M. mildek@eunet.yu
Three-part Clinical Question: In patients with an acute myocardial
infarction, does adjuvant hyperbaric oxygen therapy improve cardiac function and
clinical outcomes?
Search Terms: Myocardial infarction, acute coronary syndrome,
thrombolysis
The Study:
Single-blinded (outcome observer) randomised controlled trial without
intention-to-treat.
The Study Patients: Patients with first acute MI, less than 70 years of
age, chest pain duration 30 to 360 minutes with S-T elevation and cardiac enzyme
rise. Probably entered within 24 hours of infarct but not clear. Not accepted if
malignant arrhythmia, severe haemodynamic instability, cardiac failure or
previous cardiac surgery.
Control group (N = 37; 37 analysed): Streptokinase 1.5 mega-units
followed by intravenous heparin infusion plus other drugs as required.
Experimental group (N = 37; 37 analysed): As above plus HBO at 2 ATA for
60 minutes. Given 45 minutes to 18 hrs (mean 10 hrs) after STK infusion.
The Evidence:
|
Event Outcome
|
Time
to Outcome |
Control
group |
HBO
group |
Relative
risk reduction |
Absolute
risk reduction |
NNT
|
|
Cardiac
Mortality |
3
weeks? |
0.027 |
0 |
100% |
0.027 |
37 |
|
95% Confidence
Intervals: |
|
-0.03 to
0.08 |
NNT = 13 to
INF NNH
= 40 to INF |
|||
|
Angiography
- collaterals |
3
weeks? |
0.243 |
0.243 |
5% |
0.027 |
37 |
|
95% Confidence
Intervals: |
-37% to 47% |
-0.20 to
0.25 |
NNT = 4 to
INF; NNH = 5 to INF |
|||
|
Angiography
- reperfusion |
3
weeks? |
0.595 |
0.595 |
0% |
0.000 |
INF |
|
95% Confidence
Intervals: |
-38% to 38% |
-0.22 to
0.22 |
NNT = 4 to
INF; NNH = 4 to INF |
|||
|
Measure |
Control
Group |
Experimental
Group |
Difference |
95% CI |
||
|
Mean |
SD |
Mean |
SD |
|||
|
Ejection fraction at 3 weeks (%) |
44.05 |
|
50.8 |
|
-6.750 |
|
|
Serum creatine phosphatase (peak in units/L) |
1,529 |
1,187 |
989 |
643 |
-988 |
-1199 to -778 |
Comments:
1. The methodology is difficult to follow and results are poorly reported. Time
of exclusions not clear.
2. Actual time period from chest pain onset to compression is not clear, but the
mean time from thrombolysis to compression was 10 hours. Outcomes might improve
if the facilities were at the same site.
3. The clinical impact of the improvements reported is unclear.
4. The relevance of these findings may be altered in the setting of early
interventional angiography.
Appraised by: Sean Hopson, James Hudgell and Mike Bennett, Prince of Wales
Hospital, Sydney ; Friday, 24 November 2006
Email: m.bennett@unsw.edu.au
Kill or Update By: November 2007