Mummification of the infarcted myocardium by high dose corticosteroids

Abstract

There is evidence that glucocorticoids reduce infarct size but their use in myocardial infarction remains controversial because of their potential adverse effects on healing of the infarct. To investigte the healing process, rats received either four parenteral doses of 50 mg/kg of methylprednisolone (MP) or saline 5 min, 3, 6 and 24 hr after coronary occlusion and their hearts were examined by light and electron microscopy 48 hr and seven days after occlusion. At 48 hr, in five untreated rats, only 12 ± 7% of injured myocytes showed the persistence of striations and a relatively intact sarcolemma despite loss of nuclei and hence appeared 'mummified' whereas in six MP-treated rats 72 ± 8% of myocytes exhibited this appearance (P < 0.001). In treated rats there were fewer phagocytes than in controls. At seven days, in severe MP-rats, mummified cells were still more prominent than in five untreated rats and there were fewer phagocytes and less collagen. In conclusion, high dose MP delays the inflammatory process and retards the disintegration of necrotic myocytes, resulting in impaired healing.