Hyperbaric oxygen therapy for acute coronary syndrome

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.