Pulse Glucocorticoid Therapy in Patients With ST-Segment Elevation Myocardial Infarction

Prior treatment

• Patients with previous acute myocardial infarction (AMI) in the assumed culprit artery.
• Previous coronary artery bypass graft (CABG).

Other illness

• Presentation with cardiac arrest (out of hospital cardiac arrest (OHCA)).
• Known allergy to glucocorticoid or known mental illness with maniac or psychotic episodes.

Other

• Time from symptoms onset to primary PCI \> 12 hours.
• Unable to read and understand Danish.

• Age ≥18 years including fertile women (It is not possible to perform a pregnancy test (HCG urine test) in the pre-hospital setting. However, methylprednisolone is not contraindicated in pregnant women).
• Acute onset of chest pain with \< 12 hours duration.
• STEMI as characterized on electrocardiogram (ECG) by one of the following:
  • 1\) at least two contiguous leads with ST-segment elevation ≥2.5 mm in men \< 40 years, ≥2 mm in men ≥40 years, or ≥1.5 mm in women in leads V2-V3 and/or ≥1 mm in the other leads, 2) presumed new left bundle branch block with ≥1 mm concordant ST-segment ele-vation in leads with a positive QRS complex, or concordant ST-segment depression ≥1 mm in V1-V3, or discordant ST-segment elevation ≥5 mm in leads with a negative QRS complex, 3) Isolated ST depression ≥0.5 mm in leads V1-V3 and ST-segment elevation (≥0.5 mm) in posterior chest wall leads V7-V9 indicating posterior acute myocardial infarc-tion (AMI), 4) ST-segment depression ≥1 mm in eight or more surface leads, coupled with ST-segment elevation in aVR and/or V1 suggesting left main-, or left main equivalent- coronary obstruction.