Long-term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: results from the METOCARD-CNIC trial (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction)
Gonzalo Pizarro, Leticia Fernández-Friera, Valentin Fuster, Rodrigo Fernández-Jiménez, José M García-Ruiz, Ana García-Álvarez, Alonso Mateos, María V Barreiro, Noemí Escalera, Maite D Rodriguez, Antonio de Miguel, Inés García-Lunar, Juan J Parra-Fuertes, Javier Sánchez-González, Luis Pardillos, Beatriz Nieto, Adriana Jiménez, Raquel Abejón, Teresa Bastante, Vicente Martínez de Vega, José A Cabrera, Beatriz López-Melgar, Gabriela Guzman, Jaime García-Prieto, Jesús G Mirelis, José Luis Zamorano, Agustín Albarrán, Javier Goicolea, Javier Escaned, Stuart Pocock, Andrés Iñiguez, Antonio Fernández-Ortiz, Vicente Sánchez-Brunete, Carlos Macaya, Borja Ibanez, Gonzalo Pizarro, Leticia Fernández-Friera, Valentin Fuster, Rodrigo Fernández-Jiménez, José M García-Ruiz, Ana García-Álvarez, Alonso Mateos, María V Barreiro, Noemí Escalera, Maite D Rodriguez, Antonio de Miguel, Inés García-Lunar, Juan J Parra-Fuertes, Javier Sánchez-González, Luis Pardillos, Beatriz Nieto, Adriana Jiménez, Raquel Abejón, Teresa Bastante, Vicente Martínez de Vega, José A Cabrera, Beatriz López-Melgar, Gabriela Guzman, Jaime García-Prieto, Jesús G Mirelis, José Luis Zamorano, Agustín Albarrán, Javier Goicolea, Javier Escaned, Stuart Pocock, Andrés Iñiguez, Antonio Fernández-Ortiz, Vicente Sánchez-Brunete, Carlos Macaya, Borja Ibanez
Abstract
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).
Keywords: ICD; LVEF; PCI; STEMI; beta-adrenergic receptors; heart failure; infarct size; magnetic resonance imaging; metoprolol; myocardial infarction.
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed