title: DETermination of the role of OXygen in suspected Acute Myocardial Infarction trial.
abstract: BACKGROUND
  The use of supplemental oxygen in the setting of suspected acute myocardial infarction (AMI) is recommended in international treatment guidelines and established in prehospital and hospital clinical routine throughout the world. However, to date there is no conclusive evidence from adequately designed and powered trials supporting this practice. Existing data are conflicting and fail to clarify the role of supplemental oxygen in AMI.
  
  
  METHODS
  A total of 6,600 normoxemic (oxygen saturation [SpO2] ≥90%) patients with suspected AMI will be randomly assigned to either supplemental oxygen 6 L/min delivered by Oxymask (MedCore Sweden AB, Kista, Sweden) for 6 to 12 hours in the treatment group or room air in the control group. Patient inclusion and randomization will take place at first medical contact, either before hospital admission or at the emergency department. The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry will be used for online randomization, allowing inclusion of a broad population of all-comers. Follow-up will be carried out in nationwide health registries and Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies. The primary objective is to evaluate whether oxygen reduces 1-year all-cause mortality. Secondary end points include 30-day mortality, major adverse cardiac events, and health economy. Prespecified subgroups include patients with confirmed AMI and certain risk groups. In a 3-month pilot study, the study concept was found to be safe and feasible.
  
  
  CONCLUSIONS
  The need to clarify the uncertainty of the role of supplemental oxygen therapy in the setting of suspected AMI is urgent. The DETO2X-AMI trial is designed and powered to address this important issue and may have a direct impact on future recommendations.
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Division of Cardiology, Södersjukhuset, Stockholm, Sweden. Electronic address: robin.hofmann@ki.se.
authors.forename: Robin
authors.initials: R
authors.lastname: Hofmann
authors.affiliation: Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Division of Cardiology, Södersjukhuset, Stockholm, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Division of Cardiology, Södersjukhuset, Stockholm, Sweden.
authors.forename: Nils
authors.initials: N
authors.lastname: Witt
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Division of Cardiology, Södersjukhuset, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Frick
authors.affiliation: Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Ollie
authors.initials: O
authors.lastname: Östlund
authors.affiliation: Department of Emergency Medicine, Medical Faculty, Lund University, Lund, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Ekelund
authors.affiliation: Department of Cardiology, Medical Faculty, Lund University, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
authors.affiliation: Department of Health Sciences, University of Borås, Borås, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
authors.affiliation: Department of Medicine, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
mesh_terms: D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D010102:Oxygen Inhalation Therapy; D012042:Registries; D013548:Sweden; D016896:Treatment Outcome