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One other important result was that patients treated with a single dose of prednisolone were statistically more likely to receive additional doses of the steroid compared to patients treated with 0.1 mg/kg (HR=1.9; 95% CI=1.2-3.4). This result was similar to those in the primary outcome measure of reduction in systolic blood pressure (RR=0.8; 95% CI=0.7-1.0) (18). Patients treated with prednisolone were also significantly more likely to obtain a favorable outcome in clinical evaluation (RR=1.0; 95% CI=1.01-1.1) as compared to patients treated with 0.1 mg/kg (HR=0.8; 95% CI=0.7-1.0) (18).
A second report by the AACC in 1999 was not published at the time but is available online (23). In this report, the data show that patients treated with prednisolone for 8 hours to 12 hours were less likely to die from acute coronary syndrome after the first dose of the steroid than patients treated for 7 hours to 10 hours (HR=0.68; 95% CI=0.42-0.92) (23).
A third report from the AACC was published in 2004 (24). In this study, patients treated with preop or with the prednisolone dose was less likely to die from any cause at the end of the study than patients treated without therapy (HR=0.54; 95% CI=0.27-0.95). The authors speculate that this result may partly reflect the fact that all patients received prednisolone at least 3 times. However, this study was not included in this guideline because its authors were not paid for their work.
In conclusion, although the results of controlled studies indicate that prednisolone has a favorable effect on acute coronary syndromes, a meta-analysis of these data and observational data based on the results of randomized trials with controlled clinical trials in humans does not support the benefits of prednisolone in the management of acute coronary syndromes.
Recommendation. Acute coronary syndromes. The use of prednisolone for management of acute coronary syndromes should be reserved for persons who do not have severe or recurrent coronary artery disease.
(1Tables 1, 2.)
Cardiovascular Effects of Prednisolone
In the review that followed, the effects of prednisolone on myocardial function were investigated as a function of the duration of
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