Steroids in Cardiac Surgery - SIRS
The goal of the trial was to evaluate treatment with steroids compared with placebo among patients undergoing cardiac surgery with cardiopulmonary bypass.
Steroids will reduce perioperative adverse events.
- Patients undergoing cardiac surgery with cardiopulmonary bypass
Number of enrollees: 7,507 patients
Duration of follow-up: 30 days
- Coprimary outcome of death
- Coprimary outcome of death, MI, stroke, renal failure, or respiratory failure
Patients undergoing surgery were randomized to methylprednisolone 500 mg IV (n = 3,755) versus placebo (n = 3,752).
Overall, 7,507 patients were randomized. The coprimary outcome of death occurred in 4.1% of the steroid group vs. 4.7% of the placebo group (p = 0.23). The coprimary outcome of death, myocardial infarction (MI), stroke, renal failure, or respiratory failure occurred in 24.3% of the steroid group vs. 23.3% of the placebo group (p = 0.31).
- MI: 13.5% vs. 11.2% (p = 0.001), respectively
- Stroke: 1.9% vs. 2.1% (p = 0.51), respectively
- Renal failure: 2.8% vs. 3.0% (p = 0.62), respectively
- Respiratory failure: 9.1% vs. 10.0% (p = 0.20), respectively
Among patients undergoing cardiac surgery with cardiopulmonary bypass the, use of methylprednisolone did not reduce death or major morbidity at 30 days. In fact, methylprednisolone was associated with an increase in MI. The prophylactic use of steroids before cardiac surgery is not recommended.
Presented by Dr. Richard Whitlock at the American College of Cardiology Scientific Session, Washington, DC, March 31, 2014.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention
Keywords: Myocardial Infarction, Stroke, Renal Insufficiency, Follow-Up Studies, Pyridinolcarbamate, Methylprednisolone, Respiratory Insufficiency, Cardiopulmonary Bypass, Cardiac Surgical Procedures, ACC Annual Scientific Session
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