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

2014; Elsevier BV; Volume: 63; Issue: 22 Linguagem: Inglês

10.1016/j.jacc.2014.03.014

1558-3597

Gonzalo Pizarro, Leticia Fernández‐Friera, Valentı́n Fuster, Rodrigo Fernández‐Jiménez, José M. García‐Ruiz, Ana García‐Álvarez, Alonso Mateos, María V. Barreiro, Noemí Escalera, Maite Rodriguez, Antonio De Miguel, Inés García‐Lunar, Juan J. Parra-Fuertes, Javier Sánchez‐González, Luis Pardillos, Beatriz Nieto, A.E. Rodríguez Jiménez, Raquel Abejón, Teresa Bastante, Vicente Martínez de Vega, José Ángel Cabrera, Beatriz López‐Melgar, Gabriela Guzmán, Jaime García‐Prieto, Jesús G. Mirelis, José Luis Zamorano, Agustín Albarrán, Javier Goicolea, Javier Escaned, Stuart J. Pocock, Andrés Íñiguez, Antonio Fernández-Ortı́z, Vicente Sánchez-Brunete, Carlos Macaya, Borja Ibáñez,

Acute Myocardial Infarction Research

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. 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). 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. 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). 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)