|
1. No significant effect of HBOT on left
ventricular stiffness assessed by echocardiography. |
Citation/s:
1. Vlahovic A, Neskovic AN, Dekleva M, Putnikovic B, Popovic ZB, Otasevic P,
Ostojic M. Hyperbaric oxygen treatment does not affect left ventricular chamber
stiffness after myocardial infarction treated with thrombolysis. American Heart
Journal 2004; 148:J1-J7. [Also Dekleva et al 2004]
Lead author's name and fax: neskovic@hotmail.com
Three-part Clinical Question: For patients with an acute myocardial
infarction, does the adjunctive administration of hyperbaric oxygen following
thrombolysis, compared to thrombolysis alone, result in any improvement in left
ventricular stiffness or infarct size?
Search Terms: myocardial infarction, cardiac enzymes, echocardiography
The Study:
Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Proven acute MI in patients under 70 years with ECG
changes and exyme rise, and without heart failure or malignant arrhythmias.
Control group (N = 37; 37 analysed): Streptokinase 1.5m IU at mean time
of 2.4 hours.
Experimental group (N = 37; 37 analysed): Streptokinase as above (mean
time to treatment 3.0 hours), followed by 100% oxygen at 2 ATA for 60 minutes
(mean time to treatment 13 hours).
The Evidence:
|
Outcome |
Time
to Outcome |
Control
group rate |
HBOT
group rate |
Relative
risk reduction |
Absolute
risk reduction |
Number
needed to treat |
|
Needed
intravenous beta-blockers |
not
known |
0.16 |
0.03 |
83% |
0.14 |
7 |
|
95% CI: |
3% to 100% |
0.01 to 0.27 |
4 to 189 |
|||
|
Needed
antiarrhythmics |
not
known |
0.30 |
0.11 |
64% |
0.19 |
5 |
|
95% CI: |
4% to 100% |
0.01 to 0.37 |
3 to 91 |
|||
|
Measure |
Control
Group |
Hyperbaric
Group |
Difference |
95% CI |
||
|
Mean |
SD |
Mean |
SD |
|||
|
Peak creatine phosphokinase level (IU) |
1529 |
1187 |
989 |
643 |
540 |
98.15 to 981.85 |
|
Wall motion score index |
1.52 |
0.7 |
1.38 |
0.5 |
0.14 |
-0.14 to 0.42 |
|
Deceleration time (early filling velocity) |
Not given |
|
Not given |
|
|
P = 0.87 |
Comments:
1. Generally this group of patients had small infarcts with a mild degree of
systolic and diastolic dysfunction. The effect of HBOT in a higher risk group is
not clear from this study.
2. There is a mean time from pain onset to HBOT of 13 hours, and this may mean
many patients missed an early time window when HBOT may have been more
efficaceous.
3. Only an indirect measure of infarct size was measured in this study - CK
levels.
Appraised by: Mike Bennett, POWH dept of Diving and Hyperbaric Medicine,
Sydney ; Friday, 6 July 2007
Email: m.bennett@unsw.edu.au
Kill or Update By: July 2008