Alonso Mateos1, Inés García-Lunar2, José M García-Ruiz3, Gonzalo Pizarro4, Rodrigo Fernández-Jiménez5, Pilar Huertas6, Ana García-Álvarez7, Leticia Fernández-Friera8, Jesús Bravo6, José Flores-Arias9, María V Barreiro9, Luisa Chayán-Zas9, Ervigio Corral10, Valentín Fuster11, Vicente Sánchez-Brunete6, Borja Ibáñez12. 1. Servicio de Urgencias Médicas de Madrid SUMMA112; Centro Nacional de Investigaciones Cardiovasculares CNIC, Madrid. 2. Centro Nacional de Investigaciones Cardiovasculares CNIC, Madrid; Hospital Quirón, Universidad Europea Madrid; Hospital Puerta de Hierro, Madrid. 3. Centro Nacional de Investigaciones Cardiovasculares CNIC, Madrid; Hospital Universitario Central de Asturias, Oviedo. 4. Centro Nacional de Investigaciones Cardiovasculares CNIC, Madrid; Hospital Quirón, Universidad Europea Madrid. 5. Centro Nacional de Investigaciones Cardiovasculares CNIC, Madrid; Hospital Clínico San Carlos, Madrid. 6. Servicio de Urgencias Médicas de Madrid SUMMA112. 7. Centro Nacional de Investigaciones Cardiovasculares CNIC, Madrid; Hospital Clinic, Barcelona. 8. Centro Nacional de Investigaciones Cardiovasculares CNIC, Madrid; Hospital Universitario Montepríncipe, Madrid. 9. Servicio de Emergencia Médica 061 Galicia Sur. 10. Servicio de Asistencia Municipal de Urgencia y Rescate (SAMUR)-Protección Civil, Madrid. 11. Centro Nacional de Investigaciones Cardiovasculares CNIC, Madrid; Mount Sinai School of Medicine, NY. 12. Centro Nacional de Investigaciones Cardiovasculares CNIC, Madrid; Hospital Clínico San Carlos, Madrid. Electronic address: bibanez@cnic.es.
Abstract
STUDY OBJECTIVE: We seek to examine the efficacy and safety of prereperfusion emergency medical services (EMS)-administered intravenous metoprolol in anterior ST-segment elevation myocardial infarction patients undergoing eventual primary angioplasty. METHODS: This is a prespecified subgroup analysis of the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction trial population, who all eventually received oral metoprolol within 12 to 24 hours. We studied patients receiving intravenous metoprolol by EMS and compared them with others treated by EMS but not receiving intravenous metoprolol. Outcomes included infarct size and left ventricular ejection fraction on cardiac magnetic resonance imaging at 1 week, and safety by measuring the incidence of the predefined combined endpoint (composite of death, malignant ventricular arrhythmias, advanced atrioventricular block, cardiogenic shock, or reinfarction) within the first 24 hours. RESULTS:From the total population of the trial (N=270), 147 patients (54%) were recruited during out-of-hospital assistance and transferred to the primary angioplasty center (74 intravenous metoprolol and 73 controls). Infarct size was smaller in patients receiving intravenous metoprolol compared with controls (23.4 [SD 15.0] versus 34.0 [SD 23.7] g; adjusted difference -11.4; 95% confidence interval [CI] -18.6 to -4.3). Left ventricular ejection fraction was higher in the intravenous metoprolol group (48.1% [SD 8.4%] versus 43.1% [SD 10.2%]; adjusted difference 5.0; 95% CI 1.6 to 8.4). Metoprolol administration did not increase the incidence of the prespecified safety combined endpoint: 6.8% versus 17.8% in controls (risk difference -11.1; 95% CI -21.5 to -0.6). CONCLUSION: Out-of-hospital administration of intravenous metoprolol by EMS within 4.5 hours of symptom onset in our subjects reduced infarct size and improved left ventricular ejection fraction with no excess of adverse events during the first 24 hours.
RCT Entities:
STUDY OBJECTIVE: We seek to examine the efficacy and safety of prereperfusion emergency medical services (EMS)-administered intravenous metoprolol in anterior ST-segment elevation myocardial infarctionpatients undergoing eventual primary angioplasty. METHODS: This is a prespecified subgroup analysis of the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction trial population, who all eventually received oral metoprolol within 12 to 24 hours. We studied patients receiving intravenous metoprolol by EMS and compared them with others treated by EMS but not receiving intravenous metoprolol. Outcomes included infarct size and left ventricular ejection fraction on cardiac magnetic resonance imaging at 1 week, and safety by measuring the incidence of the predefined combined endpoint (composite of death, malignant ventricular arrhythmias, advanced atrioventricular block, cardiogenic shock, or reinfarction) within the first 24 hours. RESULTS: From the total population of the trial (N=270), 147 patients (54%) were recruited during out-of-hospital assistance and transferred to the primary angioplasty center (74 intravenous metoprolol and 73 controls). Infarct size was smaller in patients receiving intravenous metoprolol compared with controls (23.4 [SD 15.0] versus 34.0 [SD 23.7] g; adjusted difference -11.4; 95% confidence interval [CI] -18.6 to -4.3). Left ventricular ejection fraction was higher in the intravenous metoprolol group (48.1% [SD 8.4%] versus 43.1% [SD 10.2%]; adjusted difference 5.0; 95% CI 1.6 to 8.4). Metoprolol administration did not increase the incidence of the prespecified safety combined endpoint: 6.8% versus 17.8% in controls (risk difference -11.1; 95% CI -21.5 to -0.6). CONCLUSION: Out-of-hospital administration of intravenous metoprolol by EMS within 4.5 hours of symptom onset in our subjects reduced infarct size and improved left ventricular ejection fraction with no excess of adverse events during the first 24 hours.
Authors: P Brian Savino; Karl A Sporer; Joe A Barger; John F Brown; Gregory H Gilbert; Kristi L Koenig; Eric M Rudnick; Angelo A Salvucci Journal: West J Emerg Med Date: 2015-12-11
Authors: Derek J Hausenloy; Jose A Barrabes; Hans Erik Bøtker; Sean M Davidson; Fabio Di Lisa; James Downey; Thomas Engstrom; Péter Ferdinandy; Hector A Carbrera-Fuentes; Gerd Heusch; Borja Ibanez; Efstathios K Iliodromitis; Javier Inserte; Robert Jennings; Neena Kalia; Rajesh Kharbanda; Sandrine Lecour; Michael Marber; Tetsuji Miura; Michel Ovize; Miguel A Perez-Pinzon; Hans Michael Piper; Karin Przyklenk; Michael Rahbek Schmidt; Andrew Redington; Marisol Ruiz-Meana; Gemma Vilahur; Jakob Vinten-Johansen; Derek M Yellon; David Garcia-Dorado Journal: Basic Res Cardiol Date: 2016-10-20 Impact factor: 17.165