Sharifi

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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

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