INFLUENCE OF HYPERBARIC OXYGENATION THERAPY (HBOT) ON RECURRENT MYOCARDIAL INFARCTION AND FIVE -YEAR SURVIVAL RATE AFTER ACUTE MYOCARDIAL INFARCTION

Abstract

Background: Surgical methods of acute myocardial infarction (MI) treatment possess a high clinical effectiveness, but at the same time, there are fixed limitations, related to the patient " s state, which is limited by medical resources and organizational problems. The development of new medical technologies allows for a better and effective non-surgical treatment of acute MI and increase long-term prognosis in this category of patients. Aim: We assessed the influence of hyperbaric oxygenation therapy on mortality rate and recurrent myocardial infarction (rMI) within 5-years monitoring. Materials and methods: The study involved 697 patients who suffered from acute MI, having undergone the standard therapy. The patients were divided at random into 2 groups: Group 1 (reference group, n=363); Group 2 (test group, n=334). Group 2 patients were given the traditional treatment, accompanied with HBOT (isopression for 40 minutes at a working pressure of 0.03 MPa). HBOT was applied on the 1 st – 5 th day following MI, the treatment course included 6 cycles, once per day. The clinical assessment was focused on clinical outcome: repeated MI eventuality and cardiovascular related mortality. Monitoring duration was 5 years. Results: HBOT application that accompanied the acute MI traditional pharmacotherapy proved to reduce rMI within 5 years following inpatient discharge (rate of rMI was 14% in the reference group and 5.4% in the test group, χ

Full text

E. A. Dotsenko et al
INFLUENCE OF HYPERBARIC OXYGENATION THERAPY (HBOT) ON RECURRENT
MYOCARDIAL INFARCTION AND FIVE - YEAR SURVIVAL RATE AFTER ACUTE
MYOCARDIAL INFARCTION
Int J Med Pharm Sci, Dec 2013 / Vol 04 (04)
Page 22
ijmps
Vol 04 issue 04
Section: Healthcare
Category: Research
Received on: 12/10/13
Revised on: 09/11/13
Accepted on: 02/12/13
INFLUENCE OF HYPERBARIC OXYGENATION THERAPY
(HBOT) ON RECURRENT MYOCARDIAL INFARCTION AND
FIVE -YEAR SURVIVAL RATE AFTER ACUTE MYOCARDIAL
INFARCTION
E. A. Dotsenko
1
, D. Salivonchyk
2
, M. O. Welcome
1
, K. E. Dotsenko
1
1
Belarusian State Medical University, Minsk, Belarus
2
Gomel State Medical University, Gomel, Belarus
E-mail of Corresponding Author: ed_dots@mail.ru
ABSTRACT
Background: Surgical methods of acute myocardial infarction (MI) treatment possess a high clinical
effectiveness, but at the same time, there are fixed limitations, related to the patient‟s state, which is
limited by medical resources and organizational problems. The development of new medical
technologies allows for a better and effective non-surgical treatment of acute MI and increase long-
term prognosis in this category of patients.
Aim: We assessed the influence of hyperbaric oxygenation therapy on mortality rate and recurrent
myocardial infarction (rMI) within 5-years monitoring.
Materials and methods: The study involved 697 patients who suffered from acute MI, having
undergone the standard therapy. The patients were divided at random into 2 groups: Group 1 (reference
group, n=363); Group 2 (test group, n=334). Group 2 patients were given the traditional treatment,
accompanied with HBOT (isopression for 40 minutes at a working pressure of 0.03 MPa). HBOT was
applied on the 1
st
– 5
th
day following MI, the treatment course included 6 cycles, once per day. The
clinical assessment was focused on clinical outcome: repeated MI eventuality and cardiovascular
related mortality. Monitoring duration was 5 years.
Results: HBOT application that accompanied the acute MI traditional pharmacotherapy proved to
reduce rMI within 5 years following inpatient discharge (rate of rMI was 14% in the reference group
and 5.4% in the test group, χ
2
=13.25, р<0.05). The joint application of HBOT and traditional
technology in treating acute MI makes it possible to raise the 5-year survival rate from 84.4% up to
95.9%.
Keywords: Hyperbaric oxygenation, Myocardial infarction, Mortality rate.
INTRODUCTION
Myocardial infarction (MI) is still considered one
of the most dangerous complications of human
atherosclerotic states, causing high mortality rate
in several groups of patients [1-6]. There is a
decrease in cases of cardiovascular mortality in
developed countries in the last decade. About 20-
30% of this effect is as a result of the better quality
of medical measures, the remaining 70-80% -
effective rehabilitation programme concerning
primary prophylactics of atherosclerosis [7-9].
However, the effectiveness of the secondary
prophylactics of atherosclerosis is lower and,
particularly, the post-MI survivors retain the risky
“hallmark” for rMI and cardiovascular related
death [10, 11]. Moreover, while acute MI inpatient
treatment technology can be assumed to have

E. A. Dotsenko et al
INFLUENCE OF HYPERBARIC OXYGENATION THERAPY (HBOT) ON RECURRENT
MYOCARDIAL INFARCTION AND FIVE - YEAR SURVIVAL RATE AFTER ACUTE
MYOCARDIAL INFARCTION
Int J Med Pharm Sci, Dec 2013 / Vol 04 (04)
Page 23
progressed immensely, the MI outpatient treatment
achievements are still much to be desired.
Retrospective studies of over 5,000 acute MI
hospital patients in USA for two decades (1975-
1995), confirmed that the repeated MI eventuality
and patients‟ mortality within a year following
their inpatient discharge did not tend to change in
any way since the late 1980s [12]: the first-year
mortality rate was limited to 10-13%, the second-
year mortality rate - 17-19%. As reported by
Capewell S et al. [13], total mortality rate of
Scottish post-MI patients within the 1
st
year
counted 31.4%, reaching 64.0% within a 10-year
period. In the population of Swedes that had MI,
the frequency of MI recurrence within a 5 year
period was 28%, and 37% within a 10 year period
[14], the total mortality within a 5 year period –
19%, and 33% within a 10 year period [15].
Analogous result was also obtained in a Danish
population [11]. According to Madsen JK and
coauthors [16] the frequency of recurrent MI after
medication was 10.5% (observation time – 2.4
years), which corresponds with the results
obtained in the American continent: in USA the
mortality within a 2-year period after MI – 28.9%
among females and 19.6% among males [6]. The
situation in developed countries has notably
improved in the new millennium. However, the
problem of repeated MI eventually and delayed
cardiovascular mortality in patients with acute rMI
remains relevant.
Evidently, the post-infarction period is influenced
by a number of factors, including clinical
peculiarities of each acute MI case, risk factors, if
any, patient‟s adaptability to the treatment being
applied etc. However, there is an unshakable
dogma for early myocardial ischemia treatment to
be a prerequisite for more favourable clinical
course.
The oxygenation technology to be applied for
ischemic heart affections therapy is based on the
idea that blood oxygen partial pressure increase
provides for elimination of tissue hypoxia, even if
reduced bloodstream is reported [18, 19]. Starting
from 1940s, patients were efficiently treated with
normobaric oxygenation, a bit later hyperbaric
oxygenation (HBOT) technology was introduced
[17, 20, 26]. The technology of hyperbaric
medicine is effective for the treatment of embolic
damage of the brain [22], Carbon monoxide
poisoning [23, 25], ischemic muscular diseases
[18], wounds [24] etc. Unfortunately, these
technologies failed to be widely used for some
reasons. Firstly, HBOT does not provide “on-the-
spot” clinical effect, as compared to drug therapy.
Besides, our medicine is traditionally oriented on
giving more rest for MI patients, thus, protecting
them from any outer impacts, including
equipment-related manipulations. Finally, we have
no established clinical practice of long-term
monitoring for MI-suffered patients and for those
treated with HBOT [21, 27]. Nowadays, oxygen
therapy (of any variant) is regarded more like a
tradition, well-founded by patho-physiologists
rather than clinical practitioners.
The aim of this study was to assess hyperbaric
oxygenation therapy influence on survival rate and
acute myocardial infarction recurrence within the
5-year monitoring.
MATERIALS AND METHODS
The study was an open, prospective, randomized
and was performed during 2005-2009 years in
cardiological hospital of Gomel region. The
commission for medical ethics found no
inconformity to the medical ethics and morality
standards.
Participation criteria: The first myocardial
infarction diagnosed verified by clinical, ECG and
biochemical analyses [28-30]; MI of at least one-
day history and at most five days history; age of
patients between 30 and 75 years; informed
consent to participation; approval by the
commission for medical ethics. Exclusion criteria:
MI after-5-day history; right ventricular infarction;
claustrophobia; oncology anamnesis; psychic
disturbances; alcohol and/or drug abuse; refusal to
participate; acute ENT diseases; unstable

E. A. Dotsenko et al
INFLUENCE OF HYPERBARIC OXYGENATION THERAPY (HBOT) ON RECURRENT
MYOCARDIAL INFARCTION AND FIVE - YEAR SURVIVAL RATE AFTER ACUTE
MYOCARDIAL INFARCTION
Int J Med Pharm Sci, Dec 2013 / Vol 04 (04)
Page 24
hemodynamics (persistent pain syndrome,
negative dynamics in ECG and lab analyses).
The study involved 697 MI patients. Treatment
regimen of MI-patients corresponded to standard
recommendation [32] and includes the myocardial
revascularization technique according to
indications (thrombolysis, angioplasty, coronary
stenting and coronary artery bypass surgery) and
drug therapy. The standard drug therapy included
aspirin, heparin, beta-blockers, ACE inhibitors,
nitroglycerin, some patients were additionally
treated with antiarrhythmic and hemodynamic
preparations [32]. The patients were randomized
into two groups: Group 1 (reference group, n=363;
274 males and 89 females, average age –
56.4±11.7 years); Group 2 (test group, n=334; 266
males and 68 females, average age – 55.5±8.2
years) (Tables 1, 2 and 3). Group 2 patients were
given the traditional treatment, accompanied with
standard HBOT by BLKS-307 (Russia, Moscow)
single-seat apparatus (isopression for 40 minutes
at working pressure – 0.03 MPa) (Fig.1). HBOT
was started on the 1
st
– 5
th
day (average – 2.3 days)
following the MI; the treatment course included 6
cycles, once per day.
Fig. 1 Hyperbaric chamber BLKS-307
The groups were homogeneous both in socio-demographic parameters and clinical characteristics: thus,
Q-wave-MI in Group 1 and 2 amounted to 71.4% and 79.3% respectively, MI anterior localization was
found in 52.6% and 48.8% of patients and thrombolysis was applied to 17.9% and 21.6% of cases
respectively (Table 2).
Table 1: Gender and demographic characteristics of MI investigated patients, n (%, M±m)
Males
Females
Age (years)
Group-1, n=363
274 (75.5±2.26)
89 (24.5±2,26)
56.4±11.7
Group-2, n=334
266 (79.6±2.21)
68 (20.4±2,21)
55.5±8.2

E. A. Dotsenko et al
INFLUENCE OF HYPERBARIC OXYGENATION THERAPY (HBOT) ON RECURRENT
MYOCARDIAL INFARCTION AND FIVE - YEAR SURVIVAL RATE AFTER ACUTE
MYOCARDIAL INFARCTION
Int J Med Pharm Sci, Dec 2013 / Vol 04 (04)
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Table 2: Clinical peculiarities of diseases, concomitant pathology among MI investigated patients,
n (%, M±m)
Group-1
Group-2
Non-Q-wave-MI
104 (28.6±2.37)
69 (20.7±2.22)
Q-wave-MI
259 (71.4±2.37)
265 (79.3±2.22)
Localization
Anterior MI
172 (47.4±2.62)
171 (51.2±2.74)
Inferior MI
191 (52.6±2.62)
163 (48.8±2.74)
Myocardial revascularization, including:
138 (38.0+2.55)
141(42.2+2.70)
Coronary artery bypass surgery
49 (13.5+1.79)
49 (14.7+1.94)
Stenting
33 (9.1+1.51)
62 (18.6+2.13)
Thrombolysis
65 (17.9±2.01)
72 (21.6±2.25)
Concomitant pathology
Arterial hypertension
242 (66.7±2.47)
214 (64.1±2.63)
Diabetes mellitus
59 (16.3±1.94)
44 (13.2±1.85)
Dislipidemia
212 (58.4±2.59)
230 (68.9±2.53)
Table 3: Frequency of complications of MI investigated patients, n (%, M±m)
MI complications
Group-1
Group-2
Heart rhythm disturbance
40 (11.0±0.66)
34 (10.2±0.68)
Conductivity disturbance
36 (9.9±0.37)
30 (9.0±0.50)
Formation of aneurysm
19 (5.2±0.24)
13 (3.9±0.14)
Acute left ventricular failure
14 (3.9±0.33)
11(3.3±0.29)
Cardiogenic shock
3 (0.8±0.18)
5 (1.5±0.22
Ventricular fibrillation
2 (0.6±0.18)
1 (0.3)
Pulmonary embolism
2 (0.6±0.18)
2 (0.6±0.18)
Apparent death
1 (0.3±0.13)
6 (1.8±0.21)
The clinical assessment was focused on recurrent MI and cardiovascular related mortality rate, as
referenced by medical histories, outpatient cards, and death certificates. Monitoring duration was 5 years.
Statistical data processing was carried out by nonparametric methods using the Pearson criterion, χ
2
and
Fischer‟s exact test.
RESULTS
When applying HBOT, no substantial and/or life-
menacing complications were observed with
Group-2 patients. Post-MI patients of both groups
under study were discharged in good state of
health to follow their sanatorium and spa
treatment. 42 patients from 1
st
group and 18
patients from 2
nd
group were excluded from our
research due to the absence of information
concerning their life-status (dead/alive) after 5
years the research had started. The clinical history
for the 5-year monitoring period is given in table
4. Thus by the end of the research we had
information on 321 patient from reference group
and 316 patients from the test group.
rMI was reported mainly with male patients (86%
of the reference group, 75% of the test group),
having MI anterior localization (86% of the
reference group, 75% of the test group). Male
mortality also prevailed (75% of the reference
group, 50% of the test group), with MI anterior
localization (75% of the reference group, 50% of
the test group). 83% of both group patients were
deceased within the first 12 months of monitoring.
The data obtained were found similar to the
information given in references [12, 13].

E. A. Dotsenko et al
INFLUENCE OF HYPERBARIC OXYGENATION THERAPY (HBOT) ON RECURRENT
MYOCARDIAL INFARCTION AND FIVE - YEAR SURVIVAL RATE AFTER ACUTE
MYOCARDIAL INFARCTION
Int J Med Pharm Sci, Dec 2013 / Vol 04 (04)
Page 26
Table 4: The rate of clinical outcome in the study groups
Indicators
Group 1
(reference)
Group 2
(test)
Statistical criterion for
significance
Total number of patients included
363
334
Total number of patients
excluded
(after 5 years)
Total
92
31
No data
42
18
M
50
13
*χ
2
=23.06, P=0.00
Total number of patients with rMI
45
17
*χ
2
=13.25, P=0.00
N/B: rMI – recurrent myocardial infarction; M –
mortality rate; * - difference validity for the 5-year
monitoring, χ
2
criterion being applied.
In all, the 5-year outcome is rather contrasting:
recurrent MI was reported in 45 people of the
reference group (14.0%), as compared to 17
people of the test group (5.4%). The χ
2
criterion
was applied to prove statistically, the considerable
decrease of rMI eventuality with HBOT-treated
patients within the 5-year period following acute
MI (χ
2
=13.25, р=0.00).
As we have shown earlier the rate of rMI patients,
who received HBOT as additional treatment, was
significantly lower, than those, who did not. At the
same time, rMI within the 2-year period was
remarkably unbalanced: the first 6 months
following acute MI is found to be the most
unfavourable [40]. The results of this present
research confirm our previous data [40], but with a
very much higher statistical significance.
Similarly, during the studied period 50 MI-
suffered patients of the reference group were
deceased as a result of co-morbidity (from total
causes) (survival rate – 84.4%). When treating
with HBOT, 13 patients were deceased during 5
years, also from total causes (survival rate -
95.9%). In the previous research [40], the 2-year
survival rate counted 86.2% for the reference
group and 94.7% for the test group. However, the
difference was found to be statistically invalid
(р>0.05). This is probably due to uneven
distribution of mortality cases within the 2-year
monitoring period. In the present research
statistical power is much higher; we managed to
gain statistical difference (χ
2
=23.06, р<0.05).
However, we should mention that time inequality
had played a role: mortality was at its peak during
the first 6 months after the MI.
DISCUSSION
In general, introduction of HBOT to acute MI
treatment provides for recurrent MI reduction
(approximately by 8%) and 5-year survival rate
increase (approximately 11%) with post-MI
patients. When discussing the study outcome,
special attention should be paid to some
conditions. First, recurrent MI eventuality and
post-MI mortality rate with the reference group
patients are similar to the generally known
information [6, 8, 11, 13]; some differences may
be found due to peculiarities of the group
organised, which is subject to exclusion criteria.
The first half-year following acute MI attack is
also well known to be the most life-dangerous
period.
Presently, the question about hyperbaric
oxygenation application for the treatment of MI
remains controversial [20]. Our results confirm the
point of view, that early HBOT application with
MI patients, results in faster eradication of
misbalanced oxygen myocardial need and
delivery, which contributes to MI area reduction,
scar healing with “softer” collagen tissue,
aneurysm prevention [34, 21]. It is demonstrated
that the influence of hyperbaric oxygenation in an
experiment prevents the development of
hypercoagulation syndrome [31], HBOT applied
immediately after coronary occlusion reduces
myocardial necrosis and acute mortality in rats
[36]. The beneficial effects of HBOT in treating
ischemia-related wounds may be mediated by
stimulating angiogenesis [33]. In addition, HBOT

E. A. Dotsenko et al
INFLUENCE OF HYPERBARIC OXYGENATION THERAPY (HBOT) ON RECURRENT
MYOCARDIAL INFARCTION AND FIVE - YEAR SURVIVAL RATE AFTER ACUTE
MYOCARDIAL INFARCTION
Int J Med Pharm Sci, Dec 2013 / Vol 04 (04)
Page 27
effects are characterised with concentration
reduction of adrenaline, noradrenaline, biogenic
amines, by myocardial electric homogeneity
stabilisation, by increased antioxidative protection
followed by lipid reduced peroxidation and
cytoprotection in early monitoring period [16, 18,
19, 21, 35]. On the other hand, results of
experiment reveal that the use of HBOT induces
catalase-activity and reduces infarct size in
ischemic rat myocardium [37]. After 6-8 months,
HBOT adaptation effects fade, and HBOT-treated
post-MI patients‟ recurrent MI and survival rate
tend to demonstrate similar characteristics, as
compared to patients treated with traditional
pharmacotherapy.
In other words, HBOT therapy is indispensable for
the first half-year following MI to reduce recurrent
MI and increase survival rate. We have used
HBOT at a pressure lower than in traditionally
applied ones (0.03 MPa). We consider that the
necessity to use the excessive dosage of oxygen
(0.1 MPa) is irrelevant, in particular due to the
activation of lipoperoxidation [38].
Ultimately, we are unable to make the decisive
assessment on the data obtained by this study.
However, the test group patients‟ lives actually
saved can serve a good recommendation to
introduce HBOT therapy, at least to treat acute MI,
subject to patients‟ strict selection. Any further
investigations might benefit specific clinical
practice and experience in this issue.
Bennett et al. in "Cochrane Database of
Systematic Reviews of Hyperbaric oxygen therapy
for acute coronary syndrome" have stated, that
HBOT followed by an episode of acute coronary
syndrome reduces the risk of death, re-infarction,
dysrhythmias. However, the small number of
studies, the modest numbers of patients, and the
methodological and reporting inadequacies of the
primary studies demand a cautious interpretation.
Thus, the adjunctive usage of HBOT in these
patients cannot be recommended to be introduced
into routine clinical practice [39].
CONCLUSION
HBOT application that accompanied the acute MI
traditional pharmacotherapy proved to reduce rMI
within 5 years following inpatient discharge (rate
of rMI was 14% in the reference group and 5.4%
in the test group, χ
2
=13.25, р<0.05). The joint
application of HBOT and traditional technology in
treating acute MI makes it possible to raise the 5-
year survival rate from 84.4% up to 95.9%.
ACKNOWLEDGEMENT
The authors are thankful to scholars whose articles
are cited and included in the reference list of this
paper. We are also grateful to all people who took
part in this study one way or the other. We extend
our gratitude to reviewers and editors and
publishers.
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MYOCARDIAL INFARCTION AND FIVE - YEAR SURVIVAL RATE AFTER ACUTE
MYOCARDIAL INFARCTION
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MYOCARDIAL INFARCTION
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