Dekleva
Hyperbaric oxygen with thrombolysis in myocardial infarction: positive effect on cardiac echo indices
| 1. Hyperbaric oxygen with thrombolysis produced improvements in left ventricular function **2. The clinical significance of this is unclear. |
- Citation/s:
1. Dekleva MN, Ostojic M, Vujnovic D. Hyperbaric oxygen and thrombolysis in acute myocardial infarction: a preliminary report. In: Sitinen SA, Leinio M, eds. Proceedings of the Twenty-first Annual Meeting of the European Underwater and Baromedical Society (EUBS), Helsinki, Finland 1995:9-13 2. Dekleva M, Neskovic A, Vlahovic A et al. Adjunctive effect of hyperbaric oxygen treatment after thrombolysis on left ventricular function in patients with acute myocardial infarction. Am Heart J 2004; 148(4):589
- Lead author's name and fax: Milica Dekleva
- Three-part Clinical Question: In patients suffering acute myocardial infarction, does the addition of hyperbaric oxygen therapy improve echocardiography / angiography results, when compared to standard therapy including a thrombolytic.
- Search Terms: Myocardial infarction, echocardiography; thrombolytic therapy
- The Study:Single-blinded (outcome observer) randomised controlled trial without intention-to-treat.
- The Study Patients: <70 years old, chest pain unrelieved by anginine, ST-segment elevation, transient CK and/or MB isoenzyme rises, 1st echo within 24 hours of pain onset. Exclusions: previous MI, bypass surgery, unstable (arrhythmia, etc), heart failure, as well as standard thrombolytic and HBOT contraindications.
- Control group (N = 37; 37 analysed): Streptokinase (1.5mU/L), followed by heparin.
- Experimental group (N = 37; 37 analysed): As above, followed by HBOT: one treatment - 2.0 ATA for 60 minutes.
- The Evidence:
| EventOutcome | 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 INFNNH 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 | ||
| Mean Outcome | Control Group | HBO Group | Difference | 95% CI | ||
| ^ | Mean | SD | Mean | SD | ^ | ^ |
| Peak CK value (U/L) | 1529 | 1187 | 989 | 643 | 540 | 98.154 to 981.846 |
| Non-Event Outcomes | Time to outcome | Control group | HBO group | P-value | ||
| Echo - ejection fraction | 3 weeks | 44.05% | 50.81% | <.001 |
- Comments:
1. Not clear if diagnosis was clinical at enrolment or after later on enzyme changes 2. Exact details of randomisation and at what point patients were excluded is unclear. 3. Results often presented graphically and as within group comparisons.4. Reperfusion was defined as reaching Thrombolysis in Myocardial Infarction (TIMI) trial classification 3.5. Mortality was the only clinical outcome.
- Appraised by: James Hudgell, Department of Diving and Hyperbaric Medicine Prince of WalesHospital; Friday, 21 October 2005Email: Kill or Update By: June 2021
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