BACKGROUND: Infarct size predicts post-infarction mortality. Oral β-blockade within 24 hours of a ST-segment elevation acute myocardial infarction (STEMI) is a class-IA indication, however early intravenous (IV) β-blockers initiation is not encouraged. In recent magnetic resonance imaging (MRI)-based experimental studies, the β(1)-blocker metoprolol has been shown to reduce infarct size only when administered before coronary reperfusion. To date, there is not a single trial comparing the pre- vs. post-reperfusion β-blocker initiation in STEMI. OBJECTIVE: The METOCARD-CNIC trial is testing whether the early initiation of IV metoprolol before primary percutaneous coronary intervention (pPCI) could reduce infarct size and improve outcomes when compared to oral post-pPCI metoprolol initiation. DESIGN: The METOCARD-CNIC trial is a randomized parallel-group single-blind (to outcome evaluators) clinical effectiveness trial conducted in 5 Counties across Spain that will enroll 220 participants. Eligible are 18- to 80-year-old patients with anterior STEMI revascularized by pPCI ≤6 hours from symptom onset. Exclusion criteria are Killip-class ≥III, atrioventricular block or active treatment with β-blockers/bronchodilators. Primary end point is infarct size evaluated by MRI 5 to 7 days post-STEMI. Prespecified major secondary end points are salvage-index, left ventricular ejection fraction recovery (day 5-7 to 6 months), the composite of (death/malignant ventricular arrhythmias/reinfarction/admission due to heart failure), and myocardial perfusion. CONCLUSIONS: The METOCARD-CNIC trial is testing the hypothesis that the early initiation of IV metoprolol pre-reperfusion reduces infarct size in comparison to initiation of oral metoprolol post-reperfusion. Given the implications of infarct size reduction in STEMI, if positive, this trial might evidence that a refined use of an approved inexpensive drug can improve outcomes of patients with STEMI.
RCT Entities:
BACKGROUND:Infarct size predicts post-infarction mortality. Oral β-blockade within 24 hours of a ST-segment elevation acute myocardial infarction (STEMI) is a class-IA indication, however early intravenous (IV) β-blockers initiation is not encouraged. In recent magnetic resonance imaging (MRI)-based experimental studies, the β(1)-blocker metoprolol has been shown to reduce infarct size only when administered before coronary reperfusion. To date, there is not a single trial comparing the pre- vs. post-reperfusion β-blocker initiation in STEMI. OBJECTIVE: The METOCARD-CNIC trial is testing whether the early initiation of IV metoprolol before primary percutaneous coronary intervention (pPCI) could reduce infarct size and improve outcomes when compared to oral post-pPCI metoprolol initiation. DESIGN: The METOCARD-CNIC trial is a randomized parallel-group single-blind (to outcome evaluators) clinical effectiveness trial conducted in 5 Counties across Spain that will enroll 220 participants. Eligible are 18- to 80-year-old patients with anterior STEMI revascularized by pPCI ≤6 hours from symptom onset. Exclusion criteria are Killip-class ≥III, atrioventricular block or active treatment with β-blockers/bronchodilators. Primary end point is infarct size evaluated by MRI 5 to 7 days post-STEMI. Prespecified major secondary end points are salvage-index, left ventricular ejection fraction recovery (day 5-7 to 6 months), the composite of (death/malignant ventricular arrhythmias/reinfarction/admission due to heart failure), and myocardial perfusion. CONCLUSIONS: The METOCARD-CNIC trial is testing the hypothesis that the early initiation of IV metoprolol pre-reperfusion reduces infarct size in comparison to initiation of oral metoprolol post-reperfusion. Given the implications of infarct size reduction in STEMI, if positive, this trial might evidence that a refined use of an approved inexpensive drug can improve outcomes of patients with STEMI.
Authors: Rodrigo Fernández-Jiménez; Jacobo Silva; Sara Martínez-Martínez; M Dolores López-Maderuelo; Mario Nuno-Ayala; José Manuel García-Ruiz; Ana García-Álvarez; Leticia Fernández-Friera; Tech Gonzalo Pizarro; Jaime García-Prieto; David Sanz-Rosa; Gonzalo López-Martin; Antonio Fernández-Ortiz; Carlos Macaya; Valentin Fuster; Juan Miguel Redondo; Borja Ibanez Journal: J Am Heart Assoc Date: 2015-01-21 Impact factor: 5.501
Authors: Joaquim Bobi; Núria Solanes; Rodrigo Fernández-Jiménez; Carlos Galán-Arriola; Ana Paula Dantas; Leticia Fernández-Friera; Carolina Gálvez-Montón; Elisabet Rigol-Monzó; Jaume Agüero; José Ramírez; Mercè Roqué; Antoni Bayés-Genís; Javier Sánchez-González; Ana García-Álvarez; Manel Sabaté; Santiago Roura; Borja Ibáñez; Montserrat Rigol Journal: J Am Heart Assoc Date: 2017-05-03 Impact factor: 5.501
Authors: Anmol Shahid; Vaibhav B Patel; Jude S Morton; Trevor H Stenson; Sandra T Davidge; Gavin Y Oudit; Michael S McMurtry Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240
Authors: Raquel P Amier; Ruben Y G Tijssen; Paul F A Teunissen; Rodrigo Fernández-Jiménez; Gonzalo Pizarro; Inés García-Lunar; Teresa Bastante; Peter M van de Ven; Aernout M Beek; Martijn W Smulders; Sebastiaan C A M Bekkers; Niels van Royen; Borja Ibanez; Robin Nijveldt Journal: J Am Heart Assoc Date: 2017-08-15 Impact factor: 5.501