Regular paper
Meta-analysis of corticosteroid treatment in acute myocardial infarction

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Abstract

Acute and chronic inflammation play a central role in the pathophysiology of atherosclerosis. Corticosteroids are the gold standard anti-inflammatory agent and may have a role in treating acute myocardial infarction. However, concern exists regarding the potential for impaired wound healing and wall thinning. The MEDLINE and PreMEDLINE databases were searched for articles from 1966 through May 2002. A total of 186 articles and 16 English-language publications were identified. A meta-analysis of mortality in controlled trials was performed. Sensitivity analyses and 2 tests for publication bias were used to test the robustness of the results. Sixteen studies involving 3,793 patients were reviewed. Most studies were small (<100 patients) and revealed conflicting efficacy using surrogate outcome measures, such as infarct size. No clear association with myocardial rupture was observed. Meta-analysis of 11 controlled trials (2,646 patients) revealed a 26% decrease in mortality with corticosteroids (odds ratio 0.74, 95% confidence interval [CI] 0.59 to 0.94; p = 0.015). Sensitivity analyses limited to large studies and randomized controlled trials revealed odds ratios of 0.76 (95% CI 0.53 to 1.09) and 0.95 (95% CI 0.72 to 1.26), respectively. Two tests revealed no evidence for publication bias. Thus, the review of available clinical studies demonstrated no harm and a possible mortality benefit of corticosteroids in acute myocardial infarction.

Section snippets

Literature search

The MEDLINE and PreMEDLINE databases were searched for articles containing the Medical Subject Heading index terms steroids, MI, heart rupture, heart aneurysm, and methylprednisolone from 1966 through May 2002. Medical Subject Heading terms were combined using simple Boolean connectors. Two reviewers extracted additional data sources from the bibliographies of articles that were identified. Studies were then chosen if they were performed in humans, written in English and had both treatment

Results

Of 186 articles identified, 16 English-language studies (3,793 patients) met our inclusion criteria, including 1 case-series, 2 retrospective case-control, and 13 prospective studies, of which 8 were randomized (Table 1). Five studies1, 2, 3, 4, 6 did not provide mortality data and were excluded from the meta-analysis.

Discussion

Methods to minimize damage in AMI have evolved from simply improving the supply–demand oxygen ratio20 in the infarcting myocardium (using supplemental oxygen and β blockers) to optimizing epicardial and microvascular reperfusion using pharmacologic and/or mechanical reperfusion strategies.21 Currently, there are investigations using experimental combinations of interventional and pharmacologic therapies that include total body cooling, therapies to limit reperfusion injury, aggressive

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