Effect of Early Metoprolol on Infarct Size in ST-Segment-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention The Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction (METOCARD-CNIC) Trial

被引:295
作者
Ibanez, Borja [1 ,2 ]
Macaya, Carlos [2 ]
Sanchez-Brunete, Vicente [3 ]
Pizarro, Gonzalo [1 ,4 ]
Fernandez-Friera, Leticia [1 ]
Mateos, Alonso [1 ,3 ]
Fernandez-Ortiz, Antonio [1 ,2 ]
Garcia-Ruiz, Jose M. [1 ]
Garcia-Alvarez, Ana [1 ]
Iniguez, Andres [5 ]
Jimenez-Borreguero, Jesus [1 ,6 ]
Lopez-Romero, Pedro [1 ]
Fernandez-Jimenez, Rodrigo [1 ,2 ]
Goicolea, Javier [7 ]
Ruiz-Mateos, Borja [2 ]
Bastante, Teresa [6 ]
Arias, Mercedes [5 ]
Iglesias-Vazquez, Jose A. [8 ]
Rodriguez, Maite D. [1 ]
Escalera, Noemi [1 ]
Acebal, Carlos [2 ]
Cabrera, Jose A. [4 ]
Valenciano, Juan [3 ]
Perez de Prado, Armando [9 ]
Fernandez-Campos, Maria J. [3 ]
Casado, Isabel [10 ]
Garcia-Rubira, Juan C. [2 ]
Garcia-Prieto, Jaime [1 ]
Sanz-Rosa, David [1 ]
Cuellas, Carlos [9 ]
Hernandez-Antolin, Rosana [2 ]
Albarran, Agustin [11 ]
Fernandez-Vazquez, Felipe [9 ]
de la Torre-Hernandez, Jose M. [12 ]
Pocock, Stuart [1 ,13 ]
Sanz, Gines [1 ]
Fuster, Valentin [1 ,14 ]
机构
[1] Ctr Nacl Invest Cardiovasc Carlos III, Madrid 28029, Spain
[2] Hosp Clin San Carlos IdISSC, Madrid, Spain
[3] Serv Urgencia Med Madrid SUMMA 112, Madrid, Spain
[4] Hosp Univ Quiron, Madrid, Spain
[5] Univ Vigo Meixoeiro, Complejo Hosp, Pontevedra, Spain
[6] Hosp Univ Princesa, Madrid, Spain
[7] Hosp Univ Puerta Hierro, Madrid, Spain
[8] Serv Emergencia Med 061 Galicia Sur, Galicia, Spain
[9] Hosp Univ Leon, Leon, Spain
[10] Serv Atenc Med Urgente SAMUR Protecc Civil, Madrid, Spain
[11] Hosp Univ Doce Octubre, Madrid, Spain
[12] Hosp Univ Marques Valdecilla, Santander, Spain
[13] London Sch Hyg & Trop Med, London WC1, England
[14] Mt Sinai Sch Med, Zena & Michael A Wiener CVI, New York, NY USA
关键词
adrenergic beta-antagonist; infarction; magnetic resonance imaging; metoprolol; myocardial infarction; percutaneous coronary intervention; reperfusion injury; INTRAVENOUS BETA-BLOCKADE; REPERFUSION INJURY; OUTCOMES; THERAPY; RISK; ANGIOPLASTY; ASPIRATION; REDUCTION; MORTALITY; EFFICACY;
D O I
10.1161/CIRCULATIONAHA.113.003653
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background The effect of -blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). Methods and Results Patients with Killip class II or less anterior ST-segment-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention within 6 hours of symptoms onset were randomized to receive intravenous metoprolol (n=131) or not (control, n=139) before reperfusion. All patients without contraindications received oral metoprolol within 24 hours. The predefined primary end point was infarct size on magnetic resonance imaging performed 5 to 7 days after STEMI. Magnetic resonance imaging was performed in 220 patients (81%). MeanSD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.615.3 versus 32.0 +/- 22.2 g; adjusted difference, -6.52; 95% confidence interval, -11.39 to -1.78; P=0.012). In patients with pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 0 to 1 flow, the adjusted treatment difference in infarct size was -8.13 (95% confidence interval, -13.10 to -3.16; P=0.0024). Infarct size estimated by peak and area under the curve creatine kinase release was measured in all study populations and was significantly reduced by intravenous metoprolol. Left ventricular ejection fraction was higher in the intravenous metoprolol group (adjusted difference, 2.67%; 95% confidence interval, 0.09-5.21; P=0.045). The composite of death, malignant ventricular arrhythmia, cardiogenic shock, atrioventricular block, and reinfarction at 24 hours in the intravenous metoprolol and control groups was 7.1% and 12.3%, respectively (P=0.21). Conclusions In patients with anterior Killip class II or less ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI.
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收藏
页码:1495 / 1503
页数:9
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