Long-Term Benefit of Early Pre-Reperfusion Metoprolol Administration in Patients With Acute Myocardial Infarction

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:63

Article

Pizarro, Gonzalo^1,2  Fernandez-Friera, Leticia^1,3  Fuster, Valentin^1,4  Fernandez-Jimenez, Rodrigo^1,5  Garcia-Ruiz, Jose M.^1,6  Garcia-Alvarez, Ana^1,7  Mateos, Alonso⁸  Barreiro, Maria V.⁹  Escalera, Noemi¹  Rodriguez, Maite D.¹  de Miguel, Antonio¹⁰  Garcia-Lunar, Ines^1,2,11  Parra-Fuertes, Juan J.¹²  Sanchez-Gonzalez, Javier^1,13  Pardillos, Luis⁸  Nieto, Beatriz¹⁰  Jimenez, Adriana¹⁴  Abejon, Raquel⁸  Bastante, Teresa¹⁵  Martinez de Vega, Vicente²  Cabrera, Jose A.²  Lopez-Melgar, Beatriz^1,12  Guzman, Gabriela^1,16  Garcia-Prieto, Jaime¹  Mirelis, Jesus G.^1,11  Luis Zamorano, Jose⁵  Albarran, Agustin¹²  Goicolea, Javier¹¹  Escaned, Javier^1,5  Pocock, Stuart^1,17  Iniguez, Andres¹⁰  Fernandez-Ortiz, Antonio^1,5  Sanchez-Brunete, Vicente⁸  Macaya, Carlos⁵  Ibanez, Borja^1,5 

[1] Ctr Nacl Invest Cardiovasc Carlos III CNIC, Madrid 28029, Spain

[2] Univ Europea Madrid, Hosp Univ Quiron, Madrid, Spain

[3] Hosp Monteprincipe, Madrid, Spain

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

[5] Hosp Clin San Carlos, Madrid, Spain

[6] Hosp Univ Cent Asturias, Oviedo, Spain

[7] Hosp Clin Barcelona, Barcelona, Spain

[8] Serv Urgencia Med Madrid SUMMA 112, Madrid, Spain

[9] Serv Emergencia Med 061 Galicia, Galicia, Spain

[10] Complejo Hosp Univ Vigo Meixoeiro, Pontevedra, Spain

[11] Hosp Univ Puerta de Hierro, Madrid, Spain

[12] Hosp Univ Doce Octubre, Madrid, Spain

[13] Philips Healthcare, Madrid, Spain

[14] Hosp Univ Leon, Leon, Spain

[15] Hosp Princesa, Madrid, Spain

[16] Hosp Univ La Paz, Madrid, Spain

[17] London Sch Hyg & Trop Med, London WC1, England

关键词: beta-adrenergic receptors;    heart failure;    ICD;    infarct size;    LVEF;    magnetic resonance imaging;    metoprolol;    myocardial infarction;    PCI;    STEMI;   

DOI  :  10.1016/j.jacc.2014.03.014

来源: Elsevier

【 摘 要 】

Objectives The goal of this trial was to study the long-term effects of intravenous (IV) metoprolol administration before reperfusion on left ventricular (LV) function and clinical events. Background Early IV metoprolol during ST-segment elevation myocardial infarction (STEMI) has been shown to reduce infarct size when used in conjunction with primary percutaneous coronary intervention (pPCI). Methods The METOCARD-CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial recruited 270 patients with KilliP =class <= II anterior STEMI presenting early after symptom onset (< 6 h) and randomized them to pre-reperfusion IV metoprolol or control group. Long-term magnetic resonance imaging (MRI) was performed on 202 patients (101 per group) 6 months after STEMI. Patients had a minimal 12-month clinical follow-up. Results Left ventricular ejection fraction (LVEF) at the 6 months MRI was higher after IV metoprolol (48.7 +/- 9.9% vs. 45.0 +/- 11.7% in control subjects; adjusted treatment effect 3.49%; 95% confidence interval [ CI]: 0.44% to 6.55%; P = 0.025). The occurrence of severely depressed LVEF (+/- 35%) at 6 months was significantly lower in patients treated with IV metoprolol (11% vs. 27%, P = 0.006). The proportion of patients fulfilling Class I indications for an implantable cardioverter-defibrillator (ICD) was significantly lower in the IV metoprolol grouP =(7% vs. 20%, P = 0.012). At a median follow-uP =of 2 years, occurrence of the pre-specified composite of death, heart failure admission, reinfarction, and malignant arrhythmias was 10.8% in the IV metoprolol grouP =versus 18.3% in the control group, adjusted hazard ratio (HR): 0.55; 95% CI: 0.26 to 1.04; P = 0.065. Heart failure admission was significantly lower in the IV metoprolol grouP =(HR: 0.32; 95% CI: 0.015 to 0.95; P = 0.046). Conclusions In patients with anterior KilliP =class <= II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer heart failure admissions. (Effect of METOprolol in CARDioproteCtioN During an Acute Myocardial InfarCtion. The METOCARD-CNIC Trial; NCT01311700) (C) 2014 by the American College of Cardiology Foundation

【 授权许可】

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