Prehospital glucocorticoid of no help in STEMI patients

Treatment with prehospital pulse-dose glucocorticoid does not appear to shrink final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) after 3 months, according to a study.

The study included 530 adults (median age 65 years, 78.9 percent male) with STEMI and less than 12 hours of acute chest pain. These patients were randomly assigned to receive either intravenous glucocorticoid (methylprednisolone 250 mg) or placebo in the prehospital setting.

Final infarct size, the primary outcome, was assessed using cardiac magnetic resonance (CMR) at 3 months, with the power calculation based on an anticipated final infarct size of 13 percent. CMR outcomes on acute scan, peak of cardiac biomarkers, clinical endpoints, and adverse events were evaluated as secondary outcomes.

A total of 401 participants (76 percent) were included in the primary outcome analysis. Of these, 198 were in the glucocorticoid group and 203 in the placebo group. Median final infarct size did not significantly differ between the glucocorticoid and placebo groups (5 percent vs 6 percent, respectively; p=0.24).

Relative to participants in the placebo group, those in the glucocorticoid group were more likely to have smaller acute infarct size (odds ratio, 0.78, 95 percent confidence interval [CI], 0.61–1.00), less microvascular obstruction (relative risk ratio, 0.83, 95 percent CI, 0.71–0.99), and greater acute left ventricular ejection fraction (mean difference, 4.44 percent, 95 percent CI, 2.01–6.87). Other secondary outcomes were similar between the two groups.

Researchers acknowledged that the trial was likely underpowered, given that the final infarct size was smaller than anticipated.