M(orphine)O(xygen)N(itrates)A(SA) in STEMI. New evidences indicates that is time to change our practice

26 Nov

In a previous post we already told about a possible interaction between Morfine and antiplatelets therapy, proposing, on the base of the new evidences, a different approach to analgesia in AMI with a more caution morphine administration in STEMI patients.

Courtesely from Dott. Guido Parodi

A recent published study, presented at American Heart Association (AHA) 2014 Scientific Sessions, also questioned oxygen use in non hypoxic STEMI patients.

The Air Versus Oxygen in ST-Elevation Myocardial Infarction (AVOID) trial compared supplemental oxygen vs no oxygen unless O₂fell below 94%.

“The AVOID study found that in patients with ST-elevation myocardial infarction who were not hypoxic, there was this suggestion that, potentially, oxygen is increasing myocardial injury, recurrent myocardial infarction, and major cardiac arrhythmia and may be associated with greater infarct size at 6 months,” lead author Dr Dion Stub (St Paul’s Hospital, Vancouver, BC, and the Baker IDI Heart and Diabetes Institute, Melbourne, Australia) concluded.

A previous Cochrane review “Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev 2013“ concluded that “current evidence neither supports nor clearly refutes the routine use of oxygen in people with AMI”, so after AVOID trial the ideal balance is more and more weighing on avoiding supplemental oxygen in STEMI non hypoxic patients.

We can affirm now that 50% of MONA acronym is, at least, reasonably questionable, and a new era in the treatment of STEMI patients is probably coming.

References:

Stub D, Smith K, Bernard, S, et al. A randomised controlled trial of oxygen therapy in acute ST-segment elevation myocardial infarction: The Air Versus Oxygen in Myocardial Infarction (AVOID) study. American Heart Association 2014 Scientific Sessions; November 19, 2014; Chicago, IL. Abstract
AVOID Oxygen? Evidence of Harm in MI. Medscape Medical News from the:American Heart Association (AHA) 2014 Scientific Sessions
Cabello JB, Burls A, Emparanza JI, et al. Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev 2013; 8:CD007160. DOI:10.1002/14651858.CD007160. Article
Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularizationof the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). European Heart Journal 2014, in press.
Parodi G, Valenti R, Bellandi B, et al. Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients: RAPID (Rapid Activity of Platelet Inhibitor Drugs) primary PCI study. J Am Coll Cardiol. 2013;61:1601-6.
Montalescot G, Van’t Hof AW, Lapostolle F, et al for the ATLANTIC Investigators. ATLANTIC Prehospital Ticagrelor in ST-Segment Elevation Myocardial Infarction. New Engl J Med 2014;

Tag:AMI, antiplatelets, Oxygen, ST elevation miocardial infarction, STEMI

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