Pretreatment with methylprednisolone improves myocardial protection during on-pump coronary artery bypass surgery.
BACKGROUND
This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB).


METHODS
Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time.


RESULTS
A comparison of patients between both groups revealed significantly high levels of IL-6 in the control group at T2, T3, and T4 with respect to T1 (T2: P &lt; .001; T3: P &lt; .001; T4: P &lt; .001). IL-10 levels were significantly higher in the study group at T2 compared with the control group (P = .007). CK-MB levels were significantly lower in the study group than in the control group at T4 (P = .001). The increase of cTnT was higher in the control group at T3 and T4 compared with the study group (T3: P = .002; T4: P = .001).


CONCLUSIONS
This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.
Department of Cardiovascular Surgery, Kolan International Hospital, Istanbul, Turkey.
Tolga
T
Demir
Department of Cardiovascular Surgery, Kolan International Hospital, Istanbul, Turkey.
Mehmet Umit
MU
Ergenoglu
Department of Anesthesiology, Kolan International Hospital, Istanbul, Turkey.
Hale Bolgi
HB
Demir
Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey.
Nursen
N
Tanrikulu
Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Mazlum
M
Sahin
Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Emre
E
Gok
Department of Cardiovascular Surgery, Kolan International Hospital, Istanbul, Turkey.
Kubilay
K
Korkut
Department of Cardiovascular Surgery, Kolan International Hospital, Istanbul, Turkey.
Ergun
E
Demirsoy
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D002316:Cardiotonic Agents / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009205:Myocarditis / Q000209:etiology* / Q000517:prevention & control*; D011292:Premedication / Q000379:methods*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D002316:Cardiotonic Agents; D008775:Methylprednisolone