Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomised Controlled Trial of Oxygen Therapy in Acute Myocardial Infarction (AVOID - Air Verses Oxygen In myocarDial Infarction Study)
Brief Summary: - Aim

The AVOID (Air Verses Oxygen In myocardial infarction) trial is designed to determine if the withholding of routine oxygen therapy in patients with acute heart attack leads to reduced heart damage compared to the current practice of routine inhaled oxygen for all patients.

- Background

There is evidence supporting and refuting the current practice of providing oxygen to all patients with acute heart attack. A recent summary of clinical trials suggested that oxygen may increase the degree of heart damage during heart attack. It also highlighted that the few trials into oxygen therapy were performed before the use of modern medications and procedures to treat heart attack and that further studies were urgently needed, using contemporary practices.

- Design

A total of 334 patients will participate in this randomized controlled trial. Patients in this study will receive the best current management and care for their condition. Patients will be randomized to routine pre-hospital care with oxygen therapy vs pre-hospital care without oxygen therapy. Patients will then receive standard hospital care, aside from allocated oxygen or no oxygen therapy. The primary outcome measure of heart damage will be investigated using routine blood tests. With additional information gathered from other aspects of routine heart care including coronary angiogram, electrocardiograms and complications of hospital stay. Patients will be followed up at 6 months to determine any longer term effects of treatment.


Options:
A: Inclusion Criteria:

* Adults ≥ 18 years of age.
* Chest pain for \< 12 hours
* ST-elevation Myocardial Infarction including either: 1) Persistent ST-segment elevation of ≥1mm in two contiguous limb leads; 2) ST-segment elevation of ≥ 2mm in two contiguous chest leads, or; 3) New left bundle branch block (LBBB) pattern.
* Able to be transported to a participating hospital

Exclusion Criteria:

* Hypoxia with oxygen saturation measured on pulse oximeter \< 94% with the patient breathing air
* Bronchospasm requiring nebulised salbutamol therapy using oxygen
* Altered conscious state
B: INCLUSION CRITERIA

Candidates for this study must meet ALL of the following criteria:

Pre-PCI:

1. Patient must be \>= 18 years of age
2. AMI must be anterior
3. Patient is experiencing clinical symptoms consistent with anterior AMI of \< 6 hour duration from time of symptom onset until admission to the emergency room
4. Complete medical history, history of AMI, previous coronary interventions, list of medications given within last 24 hours
5. 12-lead qualifying ECG criteria: Anterior infarction (ST-segment elevation \> 1 mm in two or more contiguous leads between V1 and V4 or new left bundle branch block (LBBB) with documentation of LAD system culprit lesion)
6. Patient provides written, Informed Consent
7. Patient and his/her physician agree to all required follow-up procedures and visits
8. Women of childbearing potential who have a negative pregnancy test (applies to female patients only)

   ANGIOGRAPHIC INCLUSION CRITERIA: These are evaluated after the subject has provided signed Informed Consent but prior to randomization:
9. Based on coronary anatomy, PCI is indicated for culprit lesion with anticipated use of an Intra-Coronary Stent
10. TIMI 0, I, or II flow is present on the initial angiographic injection of the infarct-related artery
11. Successful angioplasty as documented by \< 50% diameter residual angiographic stenosis within and associated with the culprit lesion and ³ TIMI II flow and no major complications such as perforation or shock
12. Documented time of reperfusion is \< 6 hours from the documented time of symptom onset

    EXCLUSION CRITERIA

    Candidates will be excluded from this study if ANY of the following conditions apply:

    Pre-PCI:
13. Patients with ventricular pseudoaneurysm, VSD, or papillary muscle rupture.
14. Absolute contraindications to anticoagulant therapy, including hemorrhagic diathesis or thrombocytopenia
15. Systemic Arterial pO2 is \< 80 mmHg with supplemental oxygen
16. Placement of an intra-aortic balloon pump (IABP)
17. Patient has had coronary bypass surgery during the 30 day period preceding PCI
18. Severe known cardiac valvular stenosis or insufficiency, pericardial disease, or non-ischemic cardiomyopathy
19. Patients requiring cardiopulmonary resuscitation for \> 10 minutes
20. Cardiogenic shock (SBP \< 80 mm Hg for more than 30 minutes unresponsive to fluids or requiring intravenous pressors or placement of an IABP)
21. Expected survival of less than 6 months due to non-cardiac condition
22. Current participation in other investigational device or drug trials that have not finished the primary efficacy endpoint follow-up parameters
23. Patient has had a hemorrhagic stroke during the 6 month period preceding PCI
24. Physician discretion regarding unacceptability for enrollment

    ANGIOGRAPHIC EXCLUSION CRITERIA: These are evaluated after the subject has provided signed Informed Consent but prior to randomization:
25. Any proximal coronary diameter stenosis \> 40 % that would restrict native flow with the Tracker-38 infusion catheter in place
26. Infarct-related vessels that are either saphenous vein grafts and/or small second order coronary vessels that do not supply significant areas of myocardium
27. Presence of a non-stented coronary dissection upon completion of the PCI procedure
28. Unprotected left main diameter stenosis \> 60%
29. Severe target vessel calcification or tortuosity
30. Multi - vessel disease that in the judgment of the investigator is best treated with emergent or urgent CABG or additional PCI within 30 days
31. In the investigator's opinion, the target vessel is unsuitable for either placing the infusion catheter or treatment with PCI
C: Inclusion Criteria:

* Stable angina or NST-ACS undergoing PCI

Exclusion Criteria:

* Blood oxygen \<95%
* Cognitive dysfunction
* STEMI
* Intubation
D: Inclusion Criteria:

* symptoms (chest pain, dyspnea) indicating acute myocardial ischemia within the last 6 hours
* ECG changes (ST-segment elevation ≥ 2 mm V1-V4, or ≥ 1 mm in other leads, ST-segment depression \>1 mm in any lead, negative T-wave in leads V2-V6, pathological Q-wave in at least 2 adjacent leads), left bundle branch block

and/or elevated levels of cardiac troponin levels in the ED

indicating acute myocardial ischemia

* oxygen saturation ≥90% (pulse oximeter)
* age ≥30

Exclusion Criteria:

* unwillingness to participate
* inability to comprehend given information
* continuous oxygen delivery at home prior to inclusion
* cardiac arrest prior to inclusion

Answer: A