Author/Authors :
Pizarro، نويسنده , , Gonzalo and Fernلndez-Friera، نويسنده , , Leticia and Fuster، نويسنده , , Valentin and Fernلndez-Jiménez، نويسنده , , Rodrigo and Garcيa-Ruiz، نويسنده , , José M. and Garcيa-ءlvarez، نويسنده , , Ana and Mateos، نويسنده , , Alonso and Barreiro، نويسنده , , Marيa V. and Escalera، نويسنده , , Noemي and Rodriguez، نويسنده , , Maite D. and de Miguel، نويسنده , , Antonio and Garcيa-Lunar، نويسنده , , Inés and Parra-Fuertes، نويسنده , , Juan J. and Sلnchez-Gonzلlez، نويسنده , , Javier and Pardillos، نويسنده , , Luis and Nieto، نويسنده , , Beatriz and Jiménez، نويسنده , , Adriana and Abejَn، نويسنده , , Raquel and Bastante، نويسنده , , Teresa and Martيnez de Vega، نويسنده , , Vicente and Cabrera، نويسنده , , José A. and Lَpez-Melgar، نويسنده , , Beatriz and Guzman، نويسنده , , Gabriela and Garcيa-Prieto، نويسنده , , Jaime and Mirelis، نويسنده , , Jesْs G. and Zamorano، نويسنده , , José Luis and Albarrلn، نويسنده , , Agustيn and Goicolea، نويسنده , , Javier and Escaned، نويسنده , , Javier and Pocock، نويسنده , , Stuart and Iٌiguez، نويسنده , , Andrés and Fernلndez-Ortiz، نويسنده , , Antonio and Sلnchez-Brunete، نويسنده , , Vicente and Macaya، نويسنده , , Carlos and Ibanez، نويسنده , , Borja، نويسنده ,
Abstract :
Objectives
al 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.
ound
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).
s
TOCARD-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.
s
entricular 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).
sions
ients 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 :
Heart Failure , ICD , infarct size , LVEF , beta-adrenergic receptors , Magnetic Resonance Imaging , Metoprolol , PCI , STEMI , Myocardial infarction
