Intraoperative high-dose dexamethasone did not significantly reduce the 30-day incidence of major adverse events compared with placebo (7.0% vs 8.5%; RR 0.83; 95% CI 0.67-1.01; P=0.07).
RCT (n=4,494)
Double-blind
randomly assigned
Yes
Does a single intraoperative dose of 1 mg/kg dexamethasone reduce a 30-day composite of death, myocardial infarction, stroke, renal failure, or respiratory failure in adults undergoing cardiac surgery with cardiopulmonary bypass?
Intraoperative high-dose dexamethasone did not significantly reduce the 30-day incidence of major adverse events in adults undergoing cardiac surgery with cardiopulmonary bypass.
Relative Risk: 0.83 (95% CI 0.67–1.01)
Absolute Event Rate: 7% vs 8.5%
Absolute Risk Reduction: -1.5%
p-value: p=0.07
CONTEXT: Prophylactic corticosteroids are often administered during cardiac surgery to attenuate the inflammatory response to cardiopulmonary bypass and surgical trauma; however, evidence that routine corticosteroid use can prevent major adverse events is lacking. OBJECTIVE: To quantify the effect of intraoperative high-dose dexamethasone on the incidence of major adverse events in patients undergoing cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, randomized, double-blind, placebo-controlled trial of 4494 patients aged 18 years or older undergoing cardiac surgery with cardiopulmonary bypass at 8 cardiac surgical centers in The Netherlands enrolled between April 13, 2006, and November 23, 2011. INTERVENTION: Patients were randomly assigned to receive a single intraoperative dose of 1 mg/kg dexamethasone (n = 2239) or placebo (n = 2255). MAIN OUTCOME MEASURES: A composite of death, myocardial infarction, stroke, renal failure, or respiratory failure, within 30 days of randomization. RESULTS: Of the 4494 patients who underwent randomization, 4482 (99.7%) could be evaluated for the primary outcome. A total of 157 patients (7.0%) in the dexamethasone group and 191 patients (8.5%) in the placebo group reached the primary study end point (relative risk, 0.83; 95% CI, 0.67-1.01; absolute risk reduction, -1.5%; 95% CI, -3.0% to 0.1%; P = .07). Dexamethasone was associated with reductions in postoperative infection, duration of postoperative mechanical ventilation, and lengths of intensive care unit and hospital stays. In contrast, dexamethasone was associated with higher postoperative glucose levels. CONCLUSION: In our trial of adults undergoing cardiac surgery, the use of intraoperative dexamethasone did not reduce the 30-day incidence of major adverse events compared with placebo. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00293592.
Jan M. Dieleman (Mon,) conducted a rct in Cardiac surgery with cardiopulmonary bypass (n=4,494). Dexamethasone vs. Placebo was evaluated on A composite of death, myocardial infarction, stroke, renal failure, or respiratory failure, within 30 days of randomization (RR 0.83, 95% CI 0.67-1.01, p=0.07). Intraoperative high-dose dexamethasone did not significantly reduce the 30-day incidence of major adverse events compared with placebo (7.0% vs 8.5%; RR 0.83; 95% CI 0.67-1.01; P=0.07).