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

被引：168

作者：

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, Alonso ^{[8
]}

Barreiro, Maria V. ^{[9
]}

Escalera, Noemi ^{[1
]}

Rodriguez, Maite D. ^{[1
]}

de Miguel, Antonio ^{[10
]}

Garcia-Lunar, Ines ^{[1
,2
,11
]}

Parra-Fuertes, Juan J. ^{[12
]}

Sanchez-Gonzalez, Javier ^{[1
,13
]}

Pardillos, Luis ^{[8
]}

Nieto, Beatriz ^{[10
]}

Jimenez, Adriana ^{[14
]}

Abejon, Raquel ^{[8
]}

Bastante, Teresa ^{[15
]}

Martinez de Vega, Vicente ^{[2
]}

Cabrera, Jose A. ^{[2
]}

Lopez-Melgar, Beatriz ^{[1
,12
]}

Guzman, Gabriela ^{[1
,16
]}

Garcia-Prieto, Jaime ^{[1
]}

Mirelis, Jesus G. ^{[1
,11
]}

Luis Zamorano, Jose ^{[5
]}

Albarran, Agustin ^{[12
]}

Goicolea, Javier ^{[11
]}

Escaned, Javier ^{[1
,5
]}

Pocock, Stuart ^{[1
,17
]}

Iniguez, Andres ^{[10
]}

Fernandez-Ortiz, Antonio ^{[1
,5
]}

Sanchez-Brunete, Vicente ^{[8
]}

Macaya, Carlos ^{[5
]}

Ibanez, Borja ^{[1
,5
]}

机构：

[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

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2014年 / 63卷 / 22期

关键词：

beta-adrenergic receptors; heart failure; ICD; infarct size; LVEF; magnetic resonance imaging; metoprolol; myocardial infarction; PCI; STEMI; IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS; HEART-FAILURE; EUROPEAN-SOCIETY; TASK-FORCE; CARDIOPROTECTION; OUTCOMES; SIZE; DETERMINANTS; TRANSLATION; GUIDELINES;

D O I：

10.1016/j.jacc.2014.03.014

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

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

引用

页码：2356 / 2362

页数：7

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