Key result
Low-dose corticosteroids (≤20 mg/kg hydrocortisone) during adult cardiac surgery did not increase the risk of myocardial infarction (OR 0.96) and significantly reduced the risk of atrial fibrillation.
Why the study?
Current guidelines and recent trials do not support prophylactic corticosteroids during cardiac surgery due to increased myocardial infarction risk and lack of benefit, prompting evaluation of whether specific dose ranges provide benefits without increasing myocardial infarction.
Do prophylactic corticosteroids reduce complications in patients undergoing cardiac surgery with cardiopulmonary bypass?
Meta-Analysis (n=18,416)
Do prophylactic corticosteroids reduce complications in patients undergoing cardiac surgery with cardiopulmonary bypass?
Low-dose prophylactic corticosteroids (≤20 mg/kg hydrocortisone equivalent) during adult cardiac surgery with cardiopulmonary bypass reduce the risk of atrial fibrillation and shorten ICU/hospital stays without increasing the risk of myocardial infarction.
Answers are grounded in this paper and cite their sources.
Low-dose corticosteroids may warrant reconsideration in adult cardiac surgery; challenges guidelines by showing benefits without increased myocardial infarction.
Background Corticosteroids can effectively inhibit systemic inflammation induced by cardiopulmonary bypass. Recently clinical trials and meta-analyses and current guidelines for cardiac surgery do not support corticosteroids prophylaxis during cardiac surgery because of an increase in myocardial infarction and no benefit for patients. The aim of this study is to determine whether specific corticosteroids dose ranges might provide clinical benefits without increasing myocardial infarction. Methods The PubMed, Web of Science, Embase, Clinical Trials, and Cochrane databases were searched for randomized controlled trials (RCTs) published before August 1, 2021. Results 88 RCTs with 18,416 patients (17,067 adults and 1,349 children) were identified. Relative to placebo and high-dose corticosteroids, low-dose corticosteroids (≤20 mg/kg hydrocortisone) during adult cardiac surgery did not increase the risks of myocardial infarction (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.43–2.17; p = 0.93). However, low-dose corticosteroids were associated with lower risks of atrial fibrillation (OR: 0.58, 95% CI: 0.44–0.76; p < 0.0001) and kidney injury (OR: 0.29, 95% CI: 0.09–0.96; p = 0.04). Furthermore, low-dose corticosteroids significantly shortened the mechanical ventilation times (mean difference [MD]: −2.74 h, 95% CI: −4.14, −1.33; p = 0.0001), intensive care unit (ICU) stay (MD: −1.48 days, 95% CI: −2.73, −0.22; p = 0.02), and hospital stay (MD: −2.29 days, 95% CI: −4.51, −0.07; p = 0.04). Conclusion Low-dose corticosteroids prophylaxis during cardiac surgery provided significant benefits for adult patients, without increasing the risks of myocardial infarction and other complications.
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Chai et al. (2022) conducted a meta-analysis in Cardiac surgery with cardiopulmonary bypass (n=18,416). Corticosteroids (low-dose ≤20 mg/kg hydrocortisone equivalent) vs. Placebo or high-dose corticosteroids was evaluated on Myocardial infarction (low-dose corticosteroids ≤20 mg/kg) (OR 0.96, 95% CI 0.43-2.17, p=0.93). Low-dose corticosteroids (≤20 mg/kg hydrocortisone) during adult cardiac surgery did not increase the risk of myocardial infarction (OR 0.96) and significantly reduced the risk of atrial fibrillation.
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