[LupusDoc]

Сообщение от plexus456

Андрей, скажите пожалуйста Вы не встречали данных по поводу выживаемости больных, у которых был ОИМ, осложенный гипотензией, замотивировавшей врача повысить давление, причем в группе А применили преднизолон, а в группе Б - дофамин?

Ни одного РКИ, где ГКС vs допамин при ОИМ с гипотензией в Medline нет (не берусь утверждать, что вообще не опубликовано, но мне не встречались ссылки на подобные трайлы).

Вот, что есть по ГКС при ОИМ:

[Ссылки доступны только зарегистрированным пользователям ]

Eight hundred and forty-nine patients with confirmed myocardial infarction were enrolled in a double-blind, placebo-controlled clinical trial of the efficacy of methylprednisolone sodium succinate (MPSS, Solu-Medrol Sterile Powder, The Upjohn Company) for reduction of morbidity and mortality following an acute myocardial infarction complicated by left ventricular failure. Two study groups were prospectively defined based on time from onset of chest pain to administration of investigational therapy. Study Group 1 received investigational therapy before 6 hours had elapsed while Study Group 2 was treated 6 to 12 hours from the onset of chest pain. Both study groups were randomized to receive either a 30 mg/kg i.v. dose of MPSS (3 g maximum) or a matching placebo at the time of study admission, to be followed by an identical dose three hours later. Definitive electrocardiograms were available for 814 patients at admission. The mortality rates at 28 days and 6 months for the anterior transmural and nontransmural infarctions did not differ significantly with regard to time to treatment or investigational therapy. For the inferior/posterior transmural infarctions, however, there was a 92% relative reduction in mortality at 28 days in the MPSS treatment arm of Study Group 2 (1/83 [1.2%] for patients given MPSS versus 15/97 [15.5%] for those given placebo; p less than 0.001). This significant difference persisted at the 6 month follow-up evaluation (3/82 [3.6%] for patients on MPSS versus 17/96 [16.6%] for those on placebo, P less than 0.01).

Пациентов довольно много, но дизайн сумбурный. В целом - никакого положительного эффекта.


[Ссылки доступны только зарегистрированным пользователям ]

Results of early studies support the concept that steroid treatment may reduce mortality from acute myocardial infarction. This double-blind, randomized, 1118-patient study was performed to determine if methylprednisolone sodium succinate (MPSS, Solu-Medrol Sterile Powder, The Upjohn Company) reduced 28-day mortality following myocardial infarction complicated by cardiac failure. Treatment with 30 mg/kg intravenous MPSS (maximum dose, 3 g) resulted in 28-day mortality rates of 11.7% with MPSS and 9.9% with placebo when treatment was initiated within six hours of the onset of chest pain (Group 1). Mortality rates at 28 days were 10.4% with MPSS and 14.7% with placebo when the treatment was initiated 6-12 hours after onset of chest pain (Group 2). In the late-treatment group, six-month mortality rates were 13.7% with MPSS and 20.3% with placebo (p = 0.08). Analysis of data by life table methods showed similar survival rates between MPSS- and placebo-treated patients in Group 1. In Group 2, survival rates were increased in MPSS-treated patients in the intervals from 48 hours through seven days (p = 0.04) and from three months through six months (p = 0.03). A Cox regression analysis showed that the relative risk of death for Group 1 patients was similar, regardless of treatment; Group 2 patients on MPSS had a significantly decreased relative risk of death (p less than 0.01). MPSS treatment was not associated with increased incidence of myocardial rupture, cardiac aneurysm, early malignant ventricular arrhythmias, or other adverse cardiac events.

Аналогично предыдущей цитате - в целом, эффекта никакого.



[Ссылки доступны только зарегистрированным пользователям ]

In this double-blind randomized study, 19 patients with acute transmural myocardial infarction were treated with methylprednisolone administered 4.4 +/- 0.7 hours (+/- SEM) after the onset of chest pain, and were compared with 21 patients who received placebo 4.5 +/- 0.4 hours after the start of clinical symptoms. The two groups were comparable in reference to sex, prevalence of risk factors, clinical status on admission, location of myocardial infarction and magnitude of ischemic injury as assessed by standard ECGs and precordial ST-segment and QRS maps. The treated patients, however, were older than the patients who received placebo. Methylprednisolone in an i.v. dose of 2.0 g was administered on admission and a similar dose was infused 3 hours later. Placebo administration followed an identical schedule. Mortality, cardiac rupture, incidence of ventricular arrhythmias, blocks, extension of myocardial infarction, pericarditis, postinfarction chest pain, persistent ST-segment elevation at discharge, and change in Killip class during hospitalization were the same in both groups. Peak enzyme values, and changes in ECG variables pertaining to resolution of ST-segment elevation or development of QRS evolutionary alterations were similar in both groups. Follow-up for 6 months did not reveal any differences in the clinical course of the two groups. Methylprednisolone infused in a total dose of 4.0 g within 12 hours after the onset of chest pain in patients with acute transmural myocardial infarction does not result in any demonstrable beneficial or harmful effects.

Здесь пациентов мало, но доза метилпреднизолона большая - эффект отсутствует (хорошо, что отрицательных эффектов не было).

[Ссылки доступны только зарегистрированным пользователям ]

Forty-two patients admitted to the Coronary Care Unit with a diagnosis of acute myocardial infarction were studied within 24 hours of the onset of symptoms. In addition to therapy determined by the attending physician, there was a double-blinded administration of either a placebo or methylprednisolone, 30 mg/kg intravenously every 6 hours for four doses. This drug had no beneficial effect on infarct size, dysrhythmias, complications, or left ventricular function 2 weeks after infarction

И снова - нет эффекта.

[Ссылки доступны только зарегистрированным пользователям ] FREE FULLTEXT

AIMS: The purpose of this study was to assess the efficacy of antiinflammatory therapy with methylprednisolone during the acute phase of unstable angina. METHODS: This is a randomized 'prospective' double-blind, placebo-controlled trial. Patients with the diagnosis of unstable angina were randomized to a 48-h course of methylprednisolone (n=81) or placebo (n=85). Patient care and therapy were otherwise decided by their attending cardiologist. The primary end-point was a composite of in-hospital recurrence of angina, silent ischaemia on Holter recording, emergency coronary revascularization, readmission with unstable angina, and myocardial infarction or death during the 30-day follow-up. RESULTS: The two groups were well balanced and had similar clinical characteristics at baseline. Forty-eight hours after randomization, mean C-reactive protein levels decreased by 2.6 mg. l(-1)in the methylprednisolone group, but increased by 1.6 mg. l(-1)in the placebo group (P=0.03). The primary end-point occurred in 44% of the methylprednisolone patients and in 33% of the placebo patients (P=0.12). Coronary revascularization rates were equal between the two groups (38% and 40%). When adjustment was made for the difference in revascularization times, a trend towards better event-free survival was seen in the control group (67% vs 57%;P=0.09). CONCLUSION: A 48 h course of antiinflammatory therapy with methylprednisolone given at the doses of this study did not improve the short-term outcome of patients with unstable angina. Copyright 2000 The European Society of Cardiology.

А это, пожалуй, наиболее адекватного дизайна исследование, хотя пациентов и немного. И снова - эффект отсутствует.