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Long term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: results from the METOCARD-CNIC trial.
J Am Coll Cardiol. 2014 Mar 24;
Authors: Pizarro G, Fernández-Friera L, Fuster V, Fernández-Jiménez R, García-Ruiz JM, García-Álvarez A, Mateos A, Barreiro MV, Escalera N, Rodriguez MD, de Miguel A, García-Lunar I, Parra-Fuertes JJ, Sánchez-González J, Pardillos L, Nieto B, Jiménez A, Abejón R, Bastante T, de Vega VM, Cabrera JA, López-Melgar B, Guzman G, García-Prieto J, Mirelis JG, Zamorano JL, Albarrán A, Goicolea J, Escaned J, Pocock S, Iñiguez A, Fernández-Ortiz A, Sánchez-Brunete V, Macaya C, Ibanez B
Abstract
OBJECTIVES: To study the long-term effects of i.v. metoprolol administration before reperfusion on left ventricular (LV) function and clinical events.
BACKGROUND: Early i.v. 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 trial recruited 270 patients with Killip-class ≤II anterior STEMI presenting early after symptom onset (<6 hours) and randomized them to pre-reperfusion i.v. metoprolol or control. Long-term magnetic-resonance-imaging (MRI) was performed on 202 patients (101 per group) 6 months after STEMI. Patients had a minimum 12-month clinical follow-up.
RESULTS: Mean (±SD) LV ejection fraction (LVEF) at 6 months MRI was higher after i.v. metoprolol (48.7±9.9% vs. 45.0±11.7% in controls; 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 i.v. metoprolol (11% vs. 27%, P=0.006). The proportion of patients fulfilling class-I indications for implantable cardioverter-defibrillator (ICD) was significantly lower in the i.v. 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, re-infarction, and malignant arrhythmia was 10.8% in i.v. metoprolol vs. 18.3% in controls, adjusted HR: 0.55; 95% CI, 0.26 to 1.04; P=0.065. Heart failure admission was significantly lower in i.v. metoprolol (HR: 0.32; 95% CI, 0.015 to 0.95; P=0.046).
CONCLUSION: In patients with anterior Killip-class ≤II STEMI undergoing pPCI, early i.v. metoprolol before reperfusion resulted in higher long term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer admissions due to heart failure.
PMID: 24694530 [PubMed - as supplied by publisher]