Gonzalo Pizarro1, Leticia Fernández-Friera2, Valentin Fuster3, Rodrigo Fernández-Jiménez4, José M García-Ruiz5, Ana García-Álvarez6, Alonso Mateos7, María V Barreiro8, Noemí Escalera9, Maite D Rodriguez9, Antonio de Miguel10, Inés García-Lunar11, Juan J Parra-Fuertes12, Javier Sánchez-González13, Luis Pardillos7, Beatriz Nieto10, Adriana Jiménez14, Raquel Abejón7, Teresa Bastante15, Vicente Martínez de Vega16, José A Cabrera16, Beatriz López-Melgar17, Gabriela Guzman18, Jaime García-Prieto9, Jesús G Mirelis19, José Luis Zamorano20, Agustín Albarrán12, Javier Goicolea21, Javier Escaned4, Stuart Pocock22, Andrés Iñiguez10, Antonio Fernández-Ortiz4, Vicente Sánchez-Brunete7, Carlos Macaya20, Borja Ibanez23. 1. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Quirón-Universidad Europea de Madrid, Madrid, Spain. 2. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Montepríncipe, Madrid, Spain. 3. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York. 4. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain. 5. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain. 6. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Clinic, Barcelona, Spain. 7. Servicio de Urgencia Médica de Madrid (SUMMA 112), Madrid, Spain. 8. Servicio de Emergencia Medica 061 de Galicia, Galicia, Spain. 9. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain. 10. Complejo Hospitalario Universitario de Vigo-Meixoeiro, Pontevedra, Spain. 11. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Quirón-Universidad Europea de Madrid, Madrid, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain. 12. Hospital Universitario Doce de Octubre, Madrid, Spain. 13. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Philips Healthcare, Madrid, Spain. 14. Hospital Universitario León, León, Spain. 15. Hospital de la Princesa, Madrid, Spain. 16. Hospital Universitario Quirón-Universidad Europea de Madrid, Madrid, Spain. 17. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Doce de Octubre, Madrid, Spain. 18. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario La Paz, Madrid, Spain. 19. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Puerta de Hierro, Madrid, Spain. 20. Hospital Clínico San Carlos, Madrid, Spain. 21. Hospital Universitario Puerta de Hierro, Madrid, Spain. 22. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; London School of Hygiene & Tropical Medicine, London, United Kingdom. 23. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain. Electronic address: bibanez@cnic.es.
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 topre-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 IVmetoprolol 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).
RCT Entities:
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).
Authors: Takashi Tanimoto; Missag H Parseghian; Takehiro Nakahara; Hideki Kawai; Navneet Narula; Dongbin Kim; Robert Nishimura; Richard H Weisbart; Grace Chan; Richard A Richieri; Nezam Haider; Farhan Chaudhry; Glenn T Reynolds; John Billimek; Francis G Blankenberg; Partho P Sengupta; Artiom D Petrov; Takashi Akasaka; H William Strauss; Jagat Narula Journal: J Am Coll Cardiol Date: 2017-09-19 Impact factor: 24.094
Authors: Ryanne P Betgem; Guus A de Waard; Robin Nijveldt; Aernout M Beek; Javier Escaned; Niels van Royen Journal: Nat Rev Cardiol Date: 2014-11-18 Impact factor: 32.419