Addition of HBOT to percutaneous coronary intervention for MI or angina reduces restenosis.

Clinical bottom line:

1. The addition of HBOT to acute MI or unstable angina patients having undergone percutaneous coronary intervention reduces the rate of the clinical restenosis.

 

Citation/s:
Sharifi M., Fares W., Abdel-Karim I. , Koch M.J., Sopdo J., Adler D. Usefulness of Hyperbaric Oxygen Therapy to Inhibit Restenosis After Percutaneous Coronary Intervention for Acute Myocardial Infarction or Unstable Angina Pectoris. Am J Cardiol 2004;93:1533-1535.
Lead author's name and fax: Mohsen Sharifi, mohsen.sharifi@ttuhsc.edu

Three-part Clinical Question: Among patients with an acute coronary syndrome who have undergone percutaneous coronary intervention (PCI), does the addition of hyperbaric oxygen therapy (HBOT) reduce the rate of coronary vessel restenosis?
Search Terms: myocardial infarction AND angina pectoris AND restenosis.

The Study:
Non-blinded randomised controlled trial without intention-to-treat.
The Study Patients: Patients with unstable ACS stabilized on medical therapy with the resolution of chest pain and normalization of ST-segment changes.
Control group (N = 37; 37 analysed): Standard PCI in de novo native or saphenous vein grafts receiving >/=1stent. Received aspirin 325mg/day and heparin during PCI and 1 month of therapy with clopidogrel 75mg/day. No additional treatments were given.
Experimental group (N = 33; 24 analysed): As above, plus two HBOT sessions involving 100% oxygen at 2ATA for 90minutes with a total chamber dwell time of 120minutes. The first HBOT commenced 2hours before or immediately after PCI while the second HBOT was given another 18 hours later.

The Evidence:

Outcome

Time to Outcome

Control group

HBO group

Relative risk reduction

Absolute risk reduction

NNT

Death

8 months

0.08

0

100%

0.08

12

95% Confidence Intervals:

45% to 100%

-0.01 to 0.17

NNT = 6 to NNF

NNH = 145 to INF

MACE

8 months

0.35

0.03

91%

0.32

3

95% Confidence Intervals:

45% to 100%

0.16 to 0.49

2 to 6

MI

8 months

0.19

0.03

84%

0.16

6

95% Confidence Intervals:

11% to 100%

0.02 to 0.30

3 to 50

Comments:
1. 5 patients allocated to HBOT arm were analysed in the control arm, therefore intention to treat not possible.
2. Follow-up angiography on all patients would have been useful to determine the rates of coronary vessel reocclusion in the two groups.
3. Effectiveness of HBO may be reduced with modern drug eluting stents.

Appraised by: Sven Todd. 2/2 4 Mingarry St, Glasgow , G20 8NT , UK ; Wednesday, 8 June 2005
Email: sventodd@gmail.com
Kill or Update By: 1 June 2007