Revisiting hyperbaric oxygen therapy in acute myocardial infarction: A systematic review and meta-analysis of cardiac recovery and survival outcomes

Abstract Background and Aims Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunctive treatment in acute myocardial infarction (AMI) due to its potential to enhance oxygen delivery and attenuate ischemia–reperfusion injury. However, its clinical benefit in the era of modern reperfusion therapy remains uncertain. Methods A systematic search was conducted in four databases to identify studies involving adult patients with AMI treated with HBOT compared with standard therapy up to March 2026. Outcomes of interest included mortality, creatine phosphokinase (CPK) levels, and left ventricular ejection fraction (LVEF). Pooled estimates were calculated using a random-effects model. Data regarding HBOT protocols, timing of administration relative to reperfusion, and reported adverse events, were also extracted for qualitative analysis. Results Nine studies involving a total of 1,401 participants (HBOT: n = 681; control: n = 720) were included. HBOT was associated with a significant reduction in mortality (RR = 0.43; 95% CI 0.24–0.79; p = 0.006), with greater benefit observed in long-term follow-up (RR = 0.28; 95% CI 0.16–0.51; p < 0.001), while no significant reduction was found in short-term mortality. HBOT also significantly reduced CPK levels (SMD = −0.42; 95% CI −0.66 to −0.17; p < 0.001) and improved LVEF (MD = 3.69%; 95% CI 1.24–6.14; p = 0.003). Heterogeneity across analyses was low to moderate. Conclusion HBOT as an adjunctive therapy in AMI is associated with improved clinical outcomes, particularly in long-term mortality and myocardial recovery.Figure 1.Graphical representation of hyperbaric oxygen therapy (HBOT) in acute myocardial infarction