Dexamethasone could improve myocardial infarction outcomes and provide new therapeutic options for non-interventional patients.
BACKGROUND
Statins reduce death and morbidity of acute myocardial infarction in part through immunosuppressive mechanisms, suggesting glucocorticoids could produce similar benefits. Glucocorticoids inhibit proliferation of smooth muscle cells and activation of macrophages within atherosclerotic plaques and protect ischemic myocardium through inhibition of a heat shock protein. Dexamethasone-eluting coronary stents have a decreased rate of restenosis, and oral prednisone reduces restenosis of conventional stents. Some studies from the 1970's and 1980's showed that steroids improve survival in myocardial infarction, but no conclusive large-scale randomized well-powered trials have been conducted.


OBJECTIVE
Dexamethasone administered alongside statins in the setting of acute myocardial infarction could attenuate myocardial damage in patients with diffuse disease.


METHODS
Patients with acute myocardial infarction who cannot undergo angioplasty or coronary artery bypass grafting could be given a statin and intravenous and oral dexamethasone. Dexamethasone minimizes fluid retention and avoids mineralocorticoid-induced cell proliferation in plaques. Blood glucose monitoring should be ordered for all patients, but diabetic patients need not be excluded. There should be measures to prevent steroid-induced homocystinuria or more common complications such as ulcers, osteoporosis, infections and psychosis.


CONCLUSIONS
Showing that acute coronary syndrome is a steroid-responsive disorder would have immediate relevance for patients limited to medical management because of anatomy and comorbidities, and results would similarly have application for acute ischemic stroke.
Alisky
Joseph Martin
JM
Marshfield Clinic Research Foundation, 1000 Oak Avenue, Marshfield, WI 54449, USA. Alisky.Joseph@Marshfieldclinic.org
D049109:Cell Proliferation; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000188:drug therapy; D003907:Dexamethasone / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008954:Models, Biological; D009203:Myocardial Infarction / Q000188:drug therapy*; D020521:Stroke / Q000188:drug therapy*; D016896:Treatment Outcome
D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D003907:Dexamethasone