Steroids and myocardial preservation

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. Methxlprednisolone (MP) effectiveness in limitation/prevention of perioperative Ml was assessed by serial ECG and serum LDH, SGOT, CPK, and CPK-MB measurements during the postoperative period in 150 patients. Of these, 75 randomly selected, received 2 Gm. of MP ½ hour prior to institution of cardiopulmonary bypass (CPB). There was no difference between the groups in operative technique, patient age, previous Ml, 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. Three of these patients 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. Nine patients in each group demonstrated ECG evidence of myocardial injury. New Q wave ST-T change, 48 nr. Total patients MP 6 3 9 No MP 5 4 9 Methylprednisolone did not reduce the incidence of perioperative myocardial injury during CABG.