TY - JOUR
T1 - Prehospital pulse-dose glucocorticoid on index of microvascular resistance in patients with ST-segment elevation myocardial infarction
T2 - a sub-study of the PULSE-MI trial
AU - Marquard, Jasmine Melissa
AU - Lønborg, Jacob
AU - Obling, Laust Emil Roelsgaard
AU - Beske, Rasmus Paulin
AU - Zhou, Yan
AU - Nepper-Christensen, Lars
AU - Vejlstrup, Niels
AU - Bang, Lia Evi
AU - Hassager, Christian
AU - Folke, Fredrik
AU - Andersen, Lars Bredevang
AU - Christensen, Helle Collatz
AU - Holmvang, Lene
AU - Pedersen, Frants
AU - Ahlehoff, Ole
AU - Jabbari, Reza
AU - Minkkinen, Mikko
AU - Sørensen, Rikke
AU - Tilsted, Hans-Henrik
AU - Engstrøm, Thomas
N1 - © 2025. The Author(s).
PY - 2025/3/18
Y1 - 2025/3/18
N2 - BACKGROUND: Microvascular injury in patients with ST-segment elevation myocardial infarction (STEMI) occurs in up to 50%, yet no therapeutic target exists. Inflammation contributes directly to myocardial damage in STEMI and may also cause deleteriously effects on the microcirculation. The aim of this prespecified sub-study was to determine the effect of prehospital pulse-dose glucocorticoid on the microcirculation determined by index of microvascular resistance (IMR) and its relation to inflammation. The PULSE-MI trial was a 1:1 randomized, blinded, placebo-controlled clinical trial in patients with STEMI transferred for primary percutaneous coronary intervention (PCI) investigating the cardioprotective effects of prehospital pulse-dose glucocorticoid (methylprednisolone 250 mg) compared with placebo. In this prespecified sub-study, we investigated microvascular function as IMR by thermodilution after primary PCI and inflammation defined by C-reactive protein (CRP) at 24 hours after onset of STEMI.RESULTS: Of 530 patients included in the PULSE-MI trial, 295 (56%) were assessed with coronary physiology of whom 142 (48%) were treated with glucocorticoid and 153 (52%) with placebo. Baseline characteristics were overall well-balanced in both groups. The median IMR in the glucocorticoid group was 23 (interquartile range (IQR), 11-38) and 18 (IQR, 11-42) in the placebo group (p=0.49). CRP upon arrival did not differ between treatment groups (p=0.81), but CRP at 24 hours was significantly lower in the glucocorticoid group compared to placebo (p<0.001).CONCLUSIONS: Prehospital glucocorticoid did not impact IMR assessed immediately after primary PCI, albeit this compound, demonstrated significant anti-inflammatory effects as determined by CRP levels at 24 hours.TRIAL REGISTRATION: http://www.CLINICALTRIALS: gov ; Unique Identifier: NCT05462730.
AB - BACKGROUND: Microvascular injury in patients with ST-segment elevation myocardial infarction (STEMI) occurs in up to 50%, yet no therapeutic target exists. Inflammation contributes directly to myocardial damage in STEMI and may also cause deleteriously effects on the microcirculation. The aim of this prespecified sub-study was to determine the effect of prehospital pulse-dose glucocorticoid on the microcirculation determined by index of microvascular resistance (IMR) and its relation to inflammation. The PULSE-MI trial was a 1:1 randomized, blinded, placebo-controlled clinical trial in patients with STEMI transferred for primary percutaneous coronary intervention (PCI) investigating the cardioprotective effects of prehospital pulse-dose glucocorticoid (methylprednisolone 250 mg) compared with placebo. In this prespecified sub-study, we investigated microvascular function as IMR by thermodilution after primary PCI and inflammation defined by C-reactive protein (CRP) at 24 hours after onset of STEMI.RESULTS: Of 530 patients included in the PULSE-MI trial, 295 (56%) were assessed with coronary physiology of whom 142 (48%) were treated with glucocorticoid and 153 (52%) with placebo. Baseline characteristics were overall well-balanced in both groups. The median IMR in the glucocorticoid group was 23 (interquartile range (IQR), 11-38) and 18 (IQR, 11-42) in the placebo group (p=0.49). CRP upon arrival did not differ between treatment groups (p=0.81), but CRP at 24 hours was significantly lower in the glucocorticoid group compared to placebo (p<0.001).CONCLUSIONS: Prehospital glucocorticoid did not impact IMR assessed immediately after primary PCI, albeit this compound, demonstrated significant anti-inflammatory effects as determined by CRP levels at 24 hours.TRIAL REGISTRATION: http://www.CLINICALTRIALS: gov ; Unique Identifier: NCT05462730.
U2 - 10.1186/s12950-025-00440-2
DO - 10.1186/s12950-025-00440-2
M3 - Article
C2 - 40102868
SN - 1476-9255
VL - 22
JO - Journal of Inflammation
JF - Journal of Inflammation
IS - 1
M1 - 12
ER -