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Hyperbaric oxygen therapy for acute coronary syndrome
1Diving and Hyperbaric Medicine, Prince of Wales Hospital, Barker St., Randwick, NSW, Australia, 2031. m.bennett@unsw.edu.au
Insights
Hyperbaric oxygen therapy (HBOT) may reduce major adverse cardiac events and pain in acute coronary syndrome (ACS) patients, but did not significantly lower mortality. Further high-quality research is needed to confirm benefits and patient selection for HBOT in ACS.
Area of Science:
- Cardiology
- Hyperbaric Medicine
- Acute Coronary Syndromes
Background:
- Acute coronary syndrome (ACS) encompasses myocardial infarction and unstable angina, posing significant mortality risks.
- Hyperbaric oxygen therapy (HBOT) enhances oxygen supply to ischemic heart tissue, potentially limiting myocardial damage.
- Adjunctive HBOT to standard ACS treatment may reduce mortality and major adverse outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of adding HBOT to standard treatment for patients with ACS.
- To assess the impact of HBOT on mortality, major adverse coronary events (MACE), dysrhythmias, and pain relief in ACS.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing HBOT with standard care for ACS.
- Searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, DORCTHIM) and contacted researchers for relevant studies up to November 2004.
- Three independent reviewers assessed trial quality and extracted data according to Cochrane Handbook guidelines.
Main Results:
- Four trials involving 462 participants were included. HBOT showed a trend towards reduced mortality (RR 0.64, P=0.08) but not statistically significant.
- Significant reductions were observed in Major Adverse Cardiac Events (MACE) (NNT 4), certain dysrhythmias including complete heart block (NNT 6), and time to pain relief (WMD 353 minutes shorter).
- One trial reported a 15% incidence of claustrophobia with HBOT in single occupancy chambers.
Conclusions:
- Adjunctive HBOT in ACS may decrease MACE, some dysrhythmias, and expedite pain relief, though mortality benefits were not proven.
- Results should be interpreted cautiously due to small trial sizes, methodological limitations, and poor reporting.
- High-quality, adequately powered trials are necessary to confirm HBOT's benefits and identify suitable patient populations; routine use is not yet justified.
Background:
Acute coronary syndrome (ACS) includes acute myocardial infarction and unstable angina. ACS is common and may prove fatal. Hyperbaric oxygen therapy (HBOT) will improve oxygen supply to the threatened heart and may reduce the volume of heart muscle that will perish. The addition of HBOT to the standard treatment may reduce death rate and other major adverse outcomes.
Objectives:
To assess the benefits and harms of adjunctive HBOT for treating ACS.
Search Strategy:
We searched the following from inception to November 2004: CENTRAL, MEDLINE, EMBASE, CINAHL, DORCTHIM, and references from selected articles. Relevant journals were handsearched and researchers in the field contacted.
Selection Criteria:
Randomised studies comparing the effect on ACS of regimens that include HBOT with those that exclude HBOT.
Data Collection And Analysis:
Three reviewers independently evaluated the quality of trials using the guidelines of the Cochrane Handbook and extracted data from included trials.
Main Results:
Four trials with 462 participants contributed to this review. There was a trend towards, but no significant decrease in, the risk of death with HBOT (relative risk (RR) 0.64, 95% CI 0.38 to 1.06, P=0.08). There was evidence from individual trials of reductions in the risk of major adverse coronary events [MACE] (RR 0.12, 95% CI 0.02 to 0.85, P=0.03; NNT 4, 95% CI 3 to 10) and some dysrhythmias following HBOT (RR 0.59, 95% CI 0.39 to 0.89, P=0.01; NNT 6, 95% CI 3 to 24), particularly complete heart block (RR 0.32, 95%CI 0.12 to 0.84, P=0.02), and that the time to relief of pain was reduced with HBOT (Weighted Mean Difference [WMD] 353 minutes shorter, 95% CI 219 to 488, P<0.0001). One trial suggested a significant incidence of claustrophobia in single occupancy chambers of 15% (RR of claustrophobia with HBOT 31.6, 95%CI 1.92 to 521, P=0.02).
Authors' Conclusions:
For people with ACS, individual small trials suggest the addition of HBOT reduced the risk of Major Adverse Cardiac Events, some dysrrhythmias, and reduced the time to relief from ischaemic pain, but did not reduce mortality. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously, and an appropriately powered trial of high methodological rigour is justified to define those patients (if any) who can be expected to derive most benefit from HBOT. The routine application of HBOT to these patients cannot be justified from this review.
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