Early diagnosis of pericarditis in acute myocardial infarction

Post-acute myocardial infarction symptomatic pericarditis (PAMISP): report on a large series and the effect of methylprednisolone therapy

One thousand one hundred and fifty-eight patients sustained a presumed myocardial infarction. Ninety-six per cent of the cases were complicated by ventricular failure. Five hundred and eighty-nine patients were randomized to receive methylprednisolone sodium succinate (MPSS, Solu-Medrol Sterile Powder, The Upjohn Company) (two doses of 2 to 3 g i.v. three hours apart within 12 hours of the onset of chest pain) and 569 to placebo. 7.5% of patients receiving MPSS and 18.5% of the patients on placebo had post-acute myocardial infarction symptomatic pericarditis (PAMISP) (p less than 0.001). The MPSS-treated patients needed less therapy for their PAMISP, and MPSS pre-treatment attenuated and limited the PAMISP. Patients who suffered PAMISP did not differ in age or sex from patients without PAMISP, but had a 3.4-fold greater incidence of anterior acute myocardial infarctions (AMIs). The literature is also reviewed to show that MPSS is a beneficial intervention in PAMISP and other pericarditides.