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Alves M, Prada L, Costa J, Ferreira JJ, Pinto FJ, Caldeira D. Effect of oxygen supply on mortality in acute ST-elevation myocardial infarction: systematic review and meta-analysis. Eur J Emerg Med 2021; 28:11-18. [PMID: 33079738 DOI: 10.1097/mej.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous studies stated that high oxygen supply in patients with myocardial infarction (MI) was not associated with improved outcomes. However, the particularities of ST-elevation myocardial infarction (STEMI) and the results of a recent trial raised the question if this subgroup of patients benefits from high oxygen supply. This study aims to evaluate the clinical effect of high oxygen supply in patients with STEMI using a systematic review of the available literature. All randomized controlled trials (RCTs) evaluating the systematic use of high oxygen (6 L/min or higher) versus room air or lower oxygen supply in STEMI patients were included. Systematic review with meta-analysis of trials retrieved in July 2020. Six databases were searched. The confidence in the pooled estimates was ascertained through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Risk of bias was evaluated using the Cochrane risk of bias tool. There were five eligible RCTs (7703 patients). High oxygen supply was associated with a significant risk reduction of short-term mortality [risk ratio (RR) 0.83; 95% confidence interval (CI), 0.70-0.98; I2 = 0%]. Mortality (longest follow-up) (RR 0.83; 95% CI, 0.71-0.97; I2 = 0%) and heart failure (RR 0.84; 95% CI, 0.60-1.18; I2 = 0%) did not present a risk reduction. Recurrent MI presented a contradictory result, favouring the lower oxygen protocol (RR 1.47; 95% CI, 0.84-2.56; I2 = 0%). The GRADE analysis was very low. High oxygen supply may be associated with a decrease in short-term mortality in STEMI patients, but the pooled data are not robust enough to allow definitive conclusions.
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Affiliation(s)
- Mariana Alves
- Serviço de Medicina III, Hospital Pulido Valente, CHLN
- Laboratory of Clinical Pharmacology and Therapeutics
- Instituto de Medicina Molecular
| | - Luísa Prada
- Laboratory of Clinical Pharmacology and Therapeutics
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics
- Instituto de Medicina Molecular
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics
- Instituto de Medicina Molecular
- CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa
- Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN
| | - Daniel Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics
- Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa
- Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN
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Viana M, Laszczyńska O, Araújo C, Borges A, Barros V, Ribeiro AI, Dias P, Maciel MJ, Moreira I, Lunet N, Azevedo A. Patient and system delays in the treatment of acute coronary syndrome. Rev Port Cardiol 2020; 39:123-131. [DOI: 10.1016/j.repc.2019.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/10/2019] [Accepted: 07/20/2019] [Indexed: 10/24/2022] Open
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Viana M, Laszczyńska O, Araújo C, Borges A, Barros V, Ribeiro AI, Dias P, Maciel MJ, Moreira I, Lunet N, Azevedo A. Patient and system delays in the treatment of acute coronary syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Caldeira D, Rodrigues B, David C, Costa J, Pinto FJ, Ferreira JJ. The association of influenza infection and vaccine with myocardial infarction: systematic review and meta-analysis of self-controlled case series. Expert Rev Vaccines 2019; 18:1211-1217. [PMID: 31693865 DOI: 10.1080/14760584.2019.1690459] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Influenza vaccination may be beneficial in coronary disease patients; however the infection and vaccination are associated with acute inflammation, a trigger of cardiovascular events. We aimed to review the risk of myocardial infarction (MI) associated with Influenza infection and the safety of vaccination in self-controlled case series (SCCS).Methods: We performed a systematic review with meta-analysis of SCCS studies to evaluate the risk of MI associated with Influenza infection/vaccination. Database search was performed in August/2018. The data were reported using the incident rate ratio (IRR) and 95% confidence interval (95%CI).Results: three studies for Influenza infection and two studies for Influenza vaccination were eligible. The risk of MI following an Influenza infection was significantly increased in the first 3 days (IRR 5.79; 95%CI: 3.59-9.38) and between 4-7 days (IRR 4.52; 95%CI: 2.80-7.32). In the first 4 weeks following the Influenza vaccination, there was a significant decrease of MI risk (IRR 0.84, 95%CI: 0.78-0.91).Conclusions: Short-term MI risk in Influenza infection is significantly increased, with a low-to-moderate confidence in the pooled evidence. The Influenza vaccine was safe regarding the short-term risk for MI, and the risk reduction is possibly related to a healthy period bias.
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Affiliation(s)
- Daniel Caldeira
- Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHLN), CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Avenida Professor Egas Moniz, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Avenida Professor Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - Bárbara Rodrigues
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Avenida Professor Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - Cláudio David
- Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHLN), CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Avenida Professor Egas Moniz, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Avenida Professor Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - João Costa
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Avenida Professor Egas Moniz, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Avenida Professor Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - Fausto J Pinto
- Faculdade de Medicina, Universidade de Lisboa. Avenida Professor Egas Moniz, Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHLN), CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Lisboa, Portugal
| | - Joaquim J Ferreira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Avenida Professor Egas Moniz, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Avenida Professor Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
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