Steroids and myocardial preservation
Codd, J.E.; Wiens, R.D.; Barner, H.B.; Kaiser, G.C.; Willman, V.L.
Journal of Thoracic and Cardiovascular Surgery 74(3): 418-422
1977
ISSN/ISBN: 0022-5223 PMID: 302373 Document Number: 122815
The use of corticosteroids in the management of acute nonoperative myocardial infarction (MI) is controversial, but experimental evidence indicates reduction of infarct size with steroid treatment. Corticosteroids are also felt to be beneficial in low-flow states because of membrane stabilization. Methylprednisolone (MP) effectiveness in limitation/prevention of perioperative MI was assessed by serial ECG and serum LDH and CPK-MB measurements during the postoperative period in 150 patients. Of these, 75 randomly selected, received 2 gm or MP .5 h prior to institution of cardiopulmonary bypass (CPB). There was no difference between the groups in operative technique, patient age, previous MI, angina severity, graft number, CPB duration, myocardial ischemia duration or graft patency. Four patients required ionotropic and intra-aortic balloon counterpulsation before removal from CPB could be accomplished. Of these patients, 3 were in the treated group and the only operative death occurred in the MP group. Analysis of enzymes did not further discriminate the incidence of MI or provide evidence of reduction of ischemic injury in the MP group. In each group, 9 patients demonstrated ECG evidence of myocardial injury.