Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:67

Article

Roolvink, Vincent¹  Ibanez, Borja^2,3  Ottervanger, Jan Paul¹  Pizarro, Gonzalo^2,4,5  van Royen, Niels⁶  Mateos, Alonso⁷  Dambrink, Jan-Henk E.¹  Escalera, Noemi²  Lipsic, Erik⁸  Albarran, Agustin^9,10  Fernandez-Ortiz, Antonio^9,11  Fernandez-Aviles, Francisco^9,12  Goicolea, Javier^9,13  Botas, Javier^9,14  Remkes, Wouter¹  Kedhi, Elvin¹  Zamorano, Jose L.¹⁵  Navarro, Felipe^3,9  Alfonso, Fernando^9,16  Garcia-Lledo, Alberto^9,17  Alonso, Joaquin^9,18  Postma, Sonja¹⁹  Kolkman, Evelien¹⁹  Gosselink, Marcel¹  de Smet, Bart²⁰  Rasoul, Saman²¹  Piek, Jan J.²²  Fuster, Valentin^2,23  Van 't Hof, Arnoud W. J.¹ 

[1] Isala Hosp, Dept Cardiol, NL-9713 AV Zwolle, Netherlands

[2] Ctr Nacl Invest Cardiovasc Carlos III CNIC, Dept Cardiol, Madrid, Spain

[3] IIS Fdn Jimenez Diaz Hosp, Dept Cardiol, E-28041 Madrid, Spain

[4] Univ Europea Madrid, Hosp Univ Quiron, Dept Cardiol, Madrid, Spain

[5] Hosp Ruber Quironsalud, Madrid, Spain

[6] Vrije Univ Amsterdam, Med Ctr, Dept Cardiol, Amsterdam, Netherlands

[7] Serv Urgencia Med Madrid SUMMA 112, Dept Cardiol, Madrid, Spain

[8] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, E-28034 Groningen, Netherlands

[9] Codigo Infarto, Dept Cardiol, Madrid, Spain

[10] Hosp 12 Octubre, Dept Cardiol, Madrid, Spain

[11] Hosp Clin San Carlos, Dept Cardiol, Madrid, Spain

[12] Hosp Gregorio Maranon, Dept Cardiol, Madrid, Spain

[13] Hosp Puerta de Hierro, Dept Cardiol, Madrid, Spain

[14] Hosp Fdn Alcorcon, Dept Cardiol, NL-6200 MD Madrid, Spain

[15] Hosp Ramon & Cajal, Dept Cardiol, NL-1105 AZ Madrid, Spain

[16] Hosp La Princesa, Dept Cardiol, Madrid, 10029, Spain

[17] Hosp Principe Asturias, Dept Cardiol, Madrid, Spain

[18] Hosp Getafe, Dept Cardiol, Madrid, Spain

[19] Diagram Diagnost Res & Management, Zwolle, Netherlands

[20] Meander Med Ctr, Dept Cardiol, Amersfoort, Netherlands

[21] Maastricht Univ, Med Ctr, Dept Cardiol, Maastricht, Netherlands

[22] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands

[23] Icahn Sch Med Mt Sinai, Zena & Michael Wiener Cardiovasc Inst, New York, NY USA

关键词: cardiac magnetic resonance;    ejection fraction;    infarct size;    metoprolol;   

DOI  :  10.1016/j.jacc.2016.03.522

来源: Elsevier

【 摘 要 】

BACKGROUND The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. OBJECTIVES This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing the effect of early IV beta-blockers before PPCI in a general ST-segment elevation myocardial infarction (STEMI) population. METHODS STEMI patients presenting <12 h from symptom onset in Killip class I to II without atrioventricular block were randomized 1:1 to IV metoprolol (2 x 5-mg bolus) or matched placebo before PPCI. Primary endpoint was myocardial infarct size as assessed by cardiac magnetic resonance imaging (CMR) at 30 days. Secondary endpoints were enzymatic infarct size and incidence of ventricular arrhythmias. Safety endpoints included symptomatic bradycardia, symptomatic hypotension, and cardiogenic shock. RESULTS A total of 683 patients (mean age 62 +/- 12 years; 75% male) were randomized to metoprolol (n = 336) or placebo (n = 346). CMR was performed in 342 patients (54.8%). Infarct size (percent of left ventricle [LV]) by CMR did not differ between the metoprolol (15.3 +/- 11.0%) and placebo groups (14.9 +/- 11.5%; p = 0.616). Peak and area under the creatine kinase curve did not differ between both groups. LV ejection fraction by CMR was 51.0 +/- 10.9% in the metoprolol group and 51.6 +/- 10.8% in the placebo group (p = 0.68). The incidence of malignant arrhythmias was 3.6% in the metoprolol group versus 6.9% in placebo (p = 0.050). The incidence of adverse events was not different between groups. CONCLUSIONS In a nonrestricted STEMI population, early intravenous metoprolol before PPCI was not associated with a reduction in infarct size. Metoprolol reduced the incidence of malignant arrhythmias in the acute phase and was not associated with an increase in adverse events. (C) 2016 by the American College of Cardiology Foundation.

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