Navigation Links
Giving steroids during bypass surgery shows no benefit, some harm
Date:3/31/2014

WASHINGTON (March 31, 2014) Giving patients steroids at the time of heart surgery does not improve health outcomes and appears to put them at greater risk of having a heart attack in the days following surgery, according to research presented at the American College of Cardiology's 63rd Annual Scientific Session. The finding, which stems from the largest randomized trial in cardiac surgery ever conducted, challenges a practice that many surgeons have used for decades.

"Based on these results, we suggest that steroids should not be used prophylactically during cardiac surgeries that require the use of cardiopulmonary bypass," said Richard Whitlock, M.D., associate professor of cardiac surgery at McMaster University, and lead investigator of the study.

Cardiopulmonary bypass, or the "heart-lung machine," is a technology that is instrumental in performing surgery for coronary heart disease and other heart conditions. More than half a million cardiac procedures are performed annually in the United States.

Steroids have been shown to reduce the body's inflammation reaction during and following the use of the heart-lung machine, though until recently no studies had evaluated whether using steroids actually improves patient outcomes. A survey conducted at the start of the trial suggests patients are currently given steroids in about 25 percent of medical centers worldwide. The use of steroids varies by country, hospital and surgeon.

"As cardiovascular disease continues to climb, cardiac surgery has become a common operation worldwide," Whitlock said. "Trying to improve the outcome for these patients is clearly imperative, and it is important to re-evaluate practices for which there is a lack of evidence and potential for harm. This study shows that administering steroids during cardiac surgery requiring bypass can cause harm."

The study involved more than 7,500 patients who underwent cardiac surgery with the use of the heart-lung machine in one of 82 participating medical centers across 18 countries spanning North America, South America, Europe, the Middle East and Asia. Half the patients were randomly assigned to receive methylprednisolone, a common steroid used to prevent inflammation, and half received a placebo. Health outcomes were assessed 30 days after surgery.

The study failed to meet both of its co-primary endpoints in that it did not show a significant benefit of steroid treatment over placebo in terms of either the overall rate of death or a composite metric that included death, heart attack, stroke, new renal failure or respiratory failure.

However, a pre-specified examination of the study's secondary endpoints, which included the rate of heart attacks, revealed that patients who received the methylprednisolone faced a 15 percent greater risk of death or heart attack and a 21 percent greater risk of heart attack alone, a pattern that was consistent across all subgroups. Of the study's 7,500 participants, 927 had a heart attack and 332 died.

The biological explanation for the increased rate of heart attack is not clear, Whitlock said, adding that the finding is specific to prophylactic steroids those given solely as prophylaxis during cardiac surgery requiring the heart-lung machine, and not for any other medical reason. The results do not suggest steroids should be stopped in cardiac surgery patients who are already taking them for other reasons.

A 2012 study of 4,000 cardiac procedures in patients of a lower risk profile in the Netherlands also found steroids had no effect on death, heart attack, stroke, new renal failure or respiratory failure. That study, however, suggested a benefit of steroids in the sub-group of high-risk patients, a finding that was not reflected in the present study.

The hospitals that participated in the trial have launched two new studies to examine other aspects of cardiac surgery.

"This trial has helped us establish a large network of surgical centers to answer important questions about cardiac surgery in a very rigorous way," Whitlock said.


'/>"/>

Contact: Beth Casteel
bcasteel@acc.org
202-375-6275
American College of Cardiology
Source:Eurekalert

Related medicine news :

1. Immigrant women giving birth in Spain suffer great stress, a study warns
2. Giving makes young children happy, UBC study suggests
3. The Alzheimer’s Caregiver™ Offers a New Educational Concept of Care That Bridges the Gap between Research and Caregiving
4. 3M™ Gripping Material Technology – Giving Golfers a Competitive Edge
5. 1 in 3 post-partum women suffers PTSD symptoms after giving birth
6. Giving lithium to those who need it
7. Kessler Foundation scientists report negative impact of long-term caregiving on cognition
8. Kick Off the Holiday Season With a Healthier Thanksgiving
9. Spread the Purple Launches New Website Just in Time for Winter Holiday Giving Season
10. Omega3 Innovations Helps Local Food Bank Provide Thanksgiving Dinners for those in Need
11. Zion Health Announces Holiday Earth Gifts for the Season of Giving Now Available at Whole Foods Market in Lafayette, CA
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/12/2017)... ... October 12, 2017 , ... The American College of Medical Informatics (ACMI) ... FACMI, during the Opening Session of AMIA’s Annual Symposium in Washington, D.C. AMIA’s ... Morris F. Collen, a pioneer in the field of medical informatics, this prestigious award ...
(Date:10/12/2017)... ANGELES (PRWEB) , ... October 12, 2017 , ... ... Parsa Mohebi Hair Restoration, has recently contributed a medical article to the newly ... on cosmetictown.com. Dr. Mohebi’s article spotlights the hair transplant procedure known as ...
(Date:10/12/2017)... , ... October 12, 2017 , ... On Saturday, October ... treadmill relay – Miles by Moonlight to raise money for the American Heart Association ... more. , Teams will work together to keep their treadmills moving for 5 ...
(Date:10/12/2017)... ... October 12, 2017 , ... ... property taxes a year. In some states—like New York, New Jersey, Massachusetts, Texas, ... many overseas retirement havens have extremely low property-tax rates, which contributes to the ...
(Date:10/12/2017)... ... October 12, 2017 , ... Vodori, ... Flow promotional review platform at the Promotional Review Committee Compliance and Best ... marketers streamline the medical, legal, and regulatory review (MLR) process – which ...
Breaking Medicine News(10 mins):
(Date:9/25/2017)... Sept. 25, 2017  EpiVax, Inc., a leader ... and immune-engineering today announced the launch of EpiVax ... of personalized therapeutic cancer vaccines. EpiVax has provided ... access to enabling technologies to the new precision ... lead EpiVax Oncology as Chief Executive Officer. Gad ...
(Date:9/19/2017)... 2017   ZirMed Inc ., a recognized leader in ... it has been ranked #1 by its users for the ... 2017 User Survey. ZirMed was recognized as the top-ranked end-to-end ... medical centers over 200 beds and holds one of the ... survey history. ...
(Date:9/12/2017)... Sept. 12, 2017  Consumer reviews on the independent review site ... the number one company for hearing aids, ranking it higher than ... brands. ... #1 by Consumers For Hearing Aids ... Hearing is an online store that provides high performance, state-of-the-art, German-engineered ...
Breaking Medicine Technology: