TY - JOUR
T1 - Long-term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction
T2 - Results from the Metocard-CNIC trial (Effect of Metoprolol in Cardioprotection during an Acute Myocardial Infarction)
AU - Pizarro, Gonzalo
AU - Fernández-Friera, Leticia
AU - Fuster, Valentin
AU - Fernández-Jiménez, Rodrigo
AU - García-Ruiz, José M.
AU - García-Álvarez, Ana
AU - Mateos, Alonso
AU - Barreiro, María V.
AU - Escalera, Noemí
AU - Rodriguez, Maite D.
AU - De Miguel, Antonio
AU - García-Lunar, Inés
AU - Parra-Fuertes, Juan J.
AU - Sánchez-González, Javier
AU - Pardillos, Luis
AU - Nieto, Beatriz
AU - Jiménez, Adriana
AU - Abejón, Raquel
AU - Bastante, Teresa
AU - Martínez De Vega, Vicente
AU - Cabrera, José A.
AU - López-Melgar, Beatriz
AU - Guzman, Gabriela
AU - García-Prieto, Jaime
AU - Mirelis, Jesús G.
AU - Zamorano, José Luis
AU - Albarrán, Agustín
AU - Goicolea, Javier
AU - Escaned, Javier
AU - Pocock, Stuart
AU - Iñiguez, Andrés
AU - Fernández-Ortiz, Antonio
AU - Sánchez-Brunete, Vicente
AU - Macaya, Carlos
AU - Ibanez, Borja
N1 - Funding Information:
The main sponsor of the METOCARD-CNIC trial was the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), through the competitive grant “ CNIC translational 01-2009 .” Other sponsors were the Spanish Ministry of Health and Social Policy (EC10-042), the Mutua Madrileña Foundation (AP8695-2011), and a Master Research Agreement (MRA) between Philips Healthcare and the CNIC. Dr. Ibanez is a recipient of the ISCIII grants “ Fondo de Investigación Sanitaria ” PI10/02268 and PI13/01979 that relate to the topic of this work. The magnetic resonance images were analyzed with dedicated software (QMass MR version 7.5), partially supported by a scientific collaboration with Medis Medical Imaging Systems BV . Dr. Pizarro, Dr. Fernández-Friera, Ms. Escalera, Mr. García-Prieto, Dr. Mirelis, Dr. Goicolea, and Dr. Ibanez are members of the Spanish “Red de Investigación Cardiovascular” (RIC; Program 4: HISPANICVS). Dr. Sánchez-González is an employee of Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Pizarro and Fernández-Friera contributed equally to this work.
PY - 2014/6/10
Y1 - 2014/6/10
N2 - 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)
AB - 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)
KW - ICD
KW - LVEF
KW - PCI
KW - STEMI
KW - beta-adrenergic receptors
KW - heart failure
KW - infarct size
KW - magnetic resonance imaging
KW - metoprolol
KW - myocardial infarction
UR - https://www.scopus.com/pages/publications/84902077740
U2 - 10.1016/j.jacc.2014.03.014
DO - 10.1016/j.jacc.2014.03.014
M3 - Article
C2 - 24694530
AN - SCOPUS:84902077740
SN - 0735-1097
VL - 63
SP - 2356
EP - 2362
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 22
ER -