Madiha Masroor FCPS, Muhammad Imran Ansari FCPS, Madiha Umair MBBS, Lalarukh Taimoor FCPS, Mujtaba Hassan FCPS, Muhammad Sohaib Arif FCPS, Musa Karim MSc, Jawed Abubaker MD, FCCP
{"title":"类固醇与心肌梗塞:调查心肌梗塞后危重患者的安全性和短期死亡率","authors":"Madiha Masroor FCPS, Muhammad Imran Ansari FCPS, Madiha Umair MBBS, Lalarukh Taimoor FCPS, Mujtaba Hassan FCPS, Muhammad Sohaib Arif FCPS, Musa Karim MSc, Jawed Abubaker MD, FCCP","doi":"10.1016/j.amjms.2024.02.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Conventionally, in the pre-percutaneous intervention era, free wall rupture is reported to be a major concern for using steroids in myocardial infarction (MI) patients. Therefore, the aim of this study was to evaluate the safety of the use of steroids in critically ill post-MI patients in terms of hospital course and short-term (up to 180-day) mortality.</p></div><div><h3>Methods</h3><p>We included patients admitted to CCU diagnosed with MI, undergone revascularization, critically ill, and requiring mechanical ventilator (MV) support. The hospital course and short-term (up to 180-day) mortality were independently compared between steroid and non-steroid cohorts and propensity-matched non-steroid cohorts.</p></div><div><h3>Results</h3><p>A total of 312 patients were included, out of which steroids were used in 93 (29.8%) patients during their management. On periodic bedside echocardiography, no free wall rupture was documented in the steroid or non-steroid cohort. When compared steroids with a propensity-matched non-steroid cohort, MV duration >24 h was 66.7% vs. 59.1%; <em>p</em> = 0.288, major bleeding was 6.5% vs. 3.2%; <em>p</em> = 0.305, need for renal replacement therapy was 9.7% vs. 8.6%; <em>p</em> = 0.799, in-hospital mortality was 35.5% vs. 23.7%; <em>p</em> = 0.077, and 180-day mortality was 48.4% vs. 41.9%; <em>p</em> = 0.377, respectively. The hazard ratio was 1.22 [95% CI: 0.80 to 1.88] compared to the propensity-matched non-steroid cohort. The ejection fraction (%) was found to be the independent predictor of 180-day mortality with an adjusted odds ratio of 0.92 [95% CI: 0.86 to 0.98].</p></div><div><h3>Conclusions</h3><p>In conclusion, using steroids is safe in post-MI patients with no significant increase in short-term mortality risk.</p></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"368 1","pages":"Pages 40-47"},"PeriodicalIF":2.3000,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Steroids and myocardial infarction: Investigating safety and short-term mortality in critical post-myocardial infarction patients\",\"authors\":\"Madiha Masroor FCPS, Muhammad Imran Ansari FCPS, Madiha Umair MBBS, Lalarukh Taimoor FCPS, Mujtaba Hassan FCPS, Muhammad Sohaib Arif FCPS, Musa Karim MSc, Jawed Abubaker MD, FCCP\",\"doi\":\"10.1016/j.amjms.2024.02.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Conventionally, in the pre-percutaneous intervention era, free wall rupture is reported to be a major concern for using steroids in myocardial infarction (MI) patients. Therefore, the aim of this study was to evaluate the safety of the use of steroids in critically ill post-MI patients in terms of hospital course and short-term (up to 180-day) mortality.</p></div><div><h3>Methods</h3><p>We included patients admitted to CCU diagnosed with MI, undergone revascularization, critically ill, and requiring mechanical ventilator (MV) support. The hospital course and short-term (up to 180-day) mortality were independently compared between steroid and non-steroid cohorts and propensity-matched non-steroid cohorts.</p></div><div><h3>Results</h3><p>A total of 312 patients were included, out of which steroids were used in 93 (29.8%) patients during their management. On periodic bedside echocardiography, no free wall rupture was documented in the steroid or non-steroid cohort. When compared steroids with a propensity-matched non-steroid cohort, MV duration >24 h was 66.7% vs. 59.1%; <em>p</em> = 0.288, major bleeding was 6.5% vs. 3.2%; <em>p</em> = 0.305, need for renal replacement therapy was 9.7% vs. 8.6%; <em>p</em> = 0.799, in-hospital mortality was 35.5% vs. 23.7%; <em>p</em> = 0.077, and 180-day mortality was 48.4% vs. 41.9%; <em>p</em> = 0.377, respectively. The hazard ratio was 1.22 [95% CI: 0.80 to 1.88] compared to the propensity-matched non-steroid cohort. The ejection fraction (%) was found to be the independent predictor of 180-day mortality with an adjusted odds ratio of 0.92 [95% CI: 0.86 to 0.98].</p></div><div><h3>Conclusions</h3><p>In conclusion, using steroids is safe in post-MI patients with no significant increase in short-term mortality risk.</p></div>\",\"PeriodicalId\":55526,\"journal\":{\"name\":\"American Journal of the Medical Sciences\",\"volume\":\"368 1\",\"pages\":\"Pages 40-47\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-02-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of the Medical Sciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0002962924011005\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of the Medical Sciences","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002962924011005","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Steroids and myocardial infarction: Investigating safety and short-term mortality in critical post-myocardial infarction patients
Background
Conventionally, in the pre-percutaneous intervention era, free wall rupture is reported to be a major concern for using steroids in myocardial infarction (MI) patients. Therefore, the aim of this study was to evaluate the safety of the use of steroids in critically ill post-MI patients in terms of hospital course and short-term (up to 180-day) mortality.
Methods
We included patients admitted to CCU diagnosed with MI, undergone revascularization, critically ill, and requiring mechanical ventilator (MV) support. The hospital course and short-term (up to 180-day) mortality were independently compared between steroid and non-steroid cohorts and propensity-matched non-steroid cohorts.
Results
A total of 312 patients were included, out of which steroids were used in 93 (29.8%) patients during their management. On periodic bedside echocardiography, no free wall rupture was documented in the steroid or non-steroid cohort. When compared steroids with a propensity-matched non-steroid cohort, MV duration >24 h was 66.7% vs. 59.1%; p = 0.288, major bleeding was 6.5% vs. 3.2%; p = 0.305, need for renal replacement therapy was 9.7% vs. 8.6%; p = 0.799, in-hospital mortality was 35.5% vs. 23.7%; p = 0.077, and 180-day mortality was 48.4% vs. 41.9%; p = 0.377, respectively. The hazard ratio was 1.22 [95% CI: 0.80 to 1.88] compared to the propensity-matched non-steroid cohort. The ejection fraction (%) was found to be the independent predictor of 180-day mortality with an adjusted odds ratio of 0.92 [95% CI: 0.86 to 0.98].
Conclusions
In conclusion, using steroids is safe in post-MI patients with no significant increase in short-term mortality risk.
期刊介绍:
The American Journal of The Medical Sciences (AJMS), founded in 1820, is the 2nd oldest medical journal in the United States. The AJMS is the official journal of the Southern Society for Clinical Investigation (SSCI). The SSCI is dedicated to the advancement of medical research and the exchange of knowledge, information and ideas. Its members are committed to mentoring future generations of medical investigators and promoting careers in academic medicine. The AJMS publishes, on a monthly basis, peer-reviewed articles in the field of internal medicine and its subspecialties, which include:
Original clinical and basic science investigations
Review articles
Online Images in the Medical Sciences
Special Features Include:
Patient-Centered Focused Reviews
History of Medicine
The Science of Medical Education.