Eligibility criteria {10}
thrombosis, coronary embolism, left bundle branch block, mental illness, maniac or psychotic, ST-segment depression, chest pain, allergy, cardiac arrest, myocarditis, coronary obstruction, anemia, takotsubo, rupture, depression
ACUTE MYOCARDIAL INFARCTION, THROMBOSIS, CORONARY ARTERY DISSECTION, ALLERGY, MYOCARDITIS, CARDIAC ARREST, CORONARY SPASM, ANEMIA, PERICARDITIS, PLAQUE, AMI, LEFT BRANCH BUNDLE BLOCK
Patients with STEMI will be screened and consecutively included in the ambulance prior to acute CAG at Rigshospitalet, Denmark. Eligibility will be checked by the referring on-call cardiology fellow (RD) at Rigshospitalet. If the patient is eligible, the including RD will ask the ambulance staff by telephone to include and randomize the patient, and thus the study medicine will be administered immediately hereafter in the ambulance.Inclusion criteriaAge ≥ 18 yearsAcute onset of chest pain with < 12 h durationSTEMI as characterized on ECG by one of the following: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,Presumed new left bundle branch block with ≥ 1 mm concordant ST-segment elevation 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,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 infarction (AMI),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.Exclusion criteriaInitial presentation with cardiac arrest (out of hospital cardiac arrest (OHCA))Known allergy to glucocorticoid or known mental illness with maniac or psychotic episodesPatients with previous AMI in the assumed culprit arteryPrevious coronary artery bypass graft (CABG)Unable to read and understand DanishOther subtypes of AMI than type 1 [A differentiation betweena classic type 1 AMI with plaque rupture and thrombosis formation and a type 2 AMI with other reasons for ST-segment elevation (e.g., takotsubo, myocarditis, pericarditis, spontaneous coronary artery dissection, coronary embolism, coronary spasm, anemia, etc [