title: A randomized placebo-controlled trial to assess the efficacy of antiinflammatory therapy with methylprednisolone in unstable angina (MUNA trial).
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors: Division of Cardiology, San Francisco General Hospital, San Francisco, CA, USA.
authors: R R
authors: RR
authors: Azar
authors: S
authors: S
authors: Rinfret
authors: P
authors: P
authors: Théroux
authors: P H
authors: PH
authors: Stone
authors: R
authors: R
authors: Dakshinamurthy
authors: Y J
authors: YJ
authors: Feng
authors: A H
authors: AH
authors: Wu
authors: G
authors: G
authors: Rangé
authors: D D
authors: DD
authors: Waters
mesh_terms: D000789:Angina, Unstable / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D000893:Anti-Inflammatory Agents; D002097:C-Reactive Protein; D008775:Methylprednisolone