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:1/23/2017)... ... January 23, 2017 , ... Ultimate ... K-20 Education Summit to be held March 23-25, 2017 in Tampa, and reminded ... 2017. , The keynote speakers include Dr. Michelle R. Weise, executive director of ...
(Date:1/23/2017)... (PRWEB) , ... January 23, 2017 , ... Sharon Kleyne, ... the air to educate listeners about the benefits of making new water infrastructure a ... Kleyne said, “it’s appropriate that we expect water infrastructure to become a top priority ...
(Date:1/23/2017)... (PRWEB) , ... January 23, 2017 , ... ... today it has earned organic certification under the USDA National Organic Program (NOP) ... Organic Certification process, we have established organic production and handling systems to complement ...
(Date:1/23/2017)... ... ... at the Mill”: a story of love and redemption, hope and uncertainty as a ... , “The Inn at the Mill” is the creation of published author, Lois Kulp, ... now living in Berks County on Crow Hill. The inn, the mill and ...
(Date:1/23/2017)... Atlanta, Georgia (PRWEB) , ... January 23, 2017 , ... Valentine’s Day is a time ... to their loved ones. For those who may be looking for the ideal present, Atlanta-based ... gift certificate and get an additional $25 free. Or, spend $200 and get $50 free. ...
Breaking Medicine News(10 mins):
(Date:1/21/2017)... 20, 2017 ResMed (NYSE: RMD ), BMC ... Winter Haven, Florida ) today announced they have agreed on ... 3B will be permitted to sell their existing products in exchange ... settlement payment to 3B to close the Florida ... an admission of liability or wrongdoing by any party. ...
(Date:1/21/2017)... , Jan. 20, 2017  Today, during ... Conference, "PI3K Pathways in Immunology, Growth Disorders ... (NASDAQ: INFI ) presented preclinical ... candidate that selectively inhibits phosphoinositide-3-kinase-gamma (PI3K-gamma). Preclinical ... help overcome resistance to checkpoint inhibition by ...
(Date:1/20/2017)... -- Research and Markets has announced the addition ... BMP, BUN Creatinine, Electrolyte Testing, HbA1c Testing, Comprehensive Metabolic Panel, Liver ... - 2024" report to their offering. ... The global clinical laboratory testing market ... Introduction of innovative solutions on the grounds of maximum efficiency and ...
Breaking Medicine Technology: