Sharifi
Addition of HBOT to percutaneous coronary intervention for MI or angina reduces re-stenosis.
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:1.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 re-stenosis?
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% CI: |
45% to 100% |
-0.01 to 0.17 |
NNT 6 to INF NNH145 to INF | |||
MACE |
8 months |
0.35 |
0.03 |
91% |
0.32 |
3 |
95% CIs: |
45% to 100% |
0.16 to 0.49 |
2 to 6 | |||
MI |
8 months |
0.19 |
0.03 |
84% |
0.16 |
6 |
95% CI: |
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 re-occlusion in the two groups.
3. Effectiveness of HBO may be reduced with modern drug eluting stents.
Appraised by:Sven Todd.; [sventodd@gmail.com] Wednesday, 8 June 2005
Kill or Update By:1 June 2024