title: Oxygen therapy in acute coronary syndrome: are the benefits worth the risk?
abstract: Oxygen supplementation is a standard treatment for all patients who present with acute coronary syndrome, regardless of oxygen saturation levels. Most of the data regarding the function of oxygen in myocardial infarction is based on a limited number of basic and clinical studies. We performed a systematic literature review that explores the basic and clinical data on the function of oxygen in ischaemic heart disease and myocardial infarction. This review discusses many aspects of oxygen treatment: (i) basic studies on the effects of oxygen in ischaemia and the potential cardiovascular effects of oxygen metabolites; (ii) clinical trials that have assessed the value of inhaled oxygen, supersaturated oxygen, and intracoronary injection of hyperoxaemic solutions in myocardial infarction; and (iii) the haemodynamic effects of oxygen in various clinical scenarios and its direct effects on the coronary vasculature. Our findings suggest that there are conflicting data on the effects of oxygen treatment. Further, the potential harmful effects of oxygen must be considered, particularly in myocardial infarction. These findings question the current guidelines and recommendations and emphasize the need for large clinical trials.
authors.affiliation: Heart Institute, Hadassah Hebrew University Medical Center, PO Box 12000, Jerusalem, Israel. monysh@gmail.com
authors.forename: Mony
authors.initials: M
authors.lastname: Shuvy
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.forename: Philippe
authors.initials: P
authors.lastname: Gabriel Steg
authors.forename: Sigrun
authors.initials: S
authors.lastname: Halvorsen
authors.forename: Sanjit
authors.initials: S
authors.lastname: Jolly
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D003326:Coronary Circulation / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D010100:Oxygen / Q000494:pharmacology / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D010100:Oxygen
keywords: Acute coronary syndrome; Myocardial infarction; Oxygen therapy