Hyperoxemic oxygen therapy in patients with acute anterior myocardial infarction: HOT-AAMI—design and rationale of a randomized trial

IF 3.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American heart journal Pub Date : 2025-03-21 DOI:10.1016/j.ahj.2025.03.013
Uwe Zeymer , Fathema Hassinger , Peter Bramlage , Andreas Schafer , Dirk Westermann , Holger Thiele , The HOT-AAMI Investigators
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Abstract

Background

Patients with acute anterior ST-elevation myocardial infarction (STEMI) are at high risk for death and heart failure (HF) despite treatment with primary percutaneous coronary intervention (PCI). Adjunctive therapy with hyperoxemic supersaturated oxygen (SSO2) following PCI reduced infarct size in previous randomized trials, but none of these trials were powered for clinical endpoints.

Aims

The HOT-AAMI trial evaluates whether hyperoxemic supersaturated oxygen (SSO2) therapy following PCI reduces the risk of death and heart failure.

Methods

HOT-AAMI is a multicenter, 1:1 randomized, open-label study across 50 sites in Germany. Patients presenting with anterior STEMI and undergoing successful PCI of the left anterior descending artery are randomized to receive SSO2 therapy on top of standard care or standard of care alone. The primary endpoint is a composite of all-cause mortality or unplanned heart failure hospital admission or outpatient visit due to heart failure requiring intravenous diuretic therapy during 12-48 months follow-up. Secondary endpoints include cardiovascular mortality, recurrent myocardial infarction, stroke, and quality of life. The sample size calculation for the HOT-AAMI trial is based on detecting a relative reduction of 25% in the primary composite endpoint. In the control group, a yearly event rate of 16% is expected, comprised of mortality (7%), hospitalization for heart failure (5%), and acute heart failure requiring outpatient treatment (4%). The study is designed to detect this 25% relative difference with a 2-sided significance level of 0.05 and 80% power, requiring a total of 393 events; therefore 1,266 patients will be enrolled.

Conclusions

The HOT-AAMI trial is the first trial powered to determine whether SSO2 therapy, administered immediately post-PCI, improves death and heart failure outcomes in patients with anterior STEMI.

Trial registration

HOT-AAMI Clinicaltrials.gov NCT06742684.
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急性前壁心肌梗死患者的高氧治疗:HOT-AAMI - 一项随机试验的设计与原理。
背景:急性st前段抬高型心肌梗死(STEMI)患者尽管接受了初级经皮冠状动脉介入治疗(PCI),但仍有较高的死亡和心力衰竭(HF)风险。在之前的随机试验中,PCI术后高氧过饱和氧(SSO2)辅助治疗可以减少梗死面积,但这些试验都没有临床终点。目的:HOT-AAMI试验评估PCI术后高氧性过饱和氧(SSO2)治疗是否能降低死亡和心力衰竭的风险。方法:HOT-AAMI是一项多中心、1:1随机、开放标签的研究,在德国50个地点进行。出现前路STEMI并成功行左前降支PCI的患者随机分为在标准治疗基础上接受SSO2治疗或单独接受标准治疗。主要终点是12-48个月随访期间因心力衰竭需要静脉利尿剂治疗而导致的全因死亡率或计划外心力衰竭住院或门诊就诊的综合。次要终点包括心血管死亡率、复发性心肌梗死、卒中和生活质量。HOT-AAMI试验的样本量计算是基于检测到主要复合终点相对减少25%。在对照组中,预计每年的事件发生率为16%,包括死亡率(7%),因心力衰竭住院(5%)和需要门诊治疗的急性心力衰竭(4%)。该研究旨在检测这25%的相对差异,双侧显著性水平为0.05,功率为80%,总共需要393个事件;因此将纳入1266例患者。结论:HOT-AAMI试验是首个旨在确定pci术后立即给予SSO2治疗是否能改善STEMI前路患者死亡和心力衰竭结局的试验。试验注册:HOT-AAMI Clinicaltrials.gov NCT06742684。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American heart journal
American heart journal 医学-心血管系统
CiteScore
8.20
自引率
2.10%
发文量
214
审稿时长
38 days
期刊介绍: The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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