Effect of Early Metoprolol on Infarct Size in ST-Segment–Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: The Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction (METOCARD-CNIC) Trial

BACKGROUND—The effect of β-blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). METHODS AND RESULTS—Patients with Killip class II o...

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Published in:	Circulation (New York, N.Y.) N.Y.), 2013-10, Vol.128 (14), p.1495-1503
Main Authors:	Ibanez, Borja, Macaya, Carlos, Sánchez-Brunete, Vicente, Pizarro, Gonzalo, Fernández-Friera, Leticia, Mateos, Alonso, Fernández-Ortiz, Antonio, García-Ruiz, José M., García-Álvarez, Ana, Iñiguez, Andrés, Jiménez-Borreguero, Jesús, López-Romero, Pedro, Fernández-Jiménez, Rodrigo, Goicolea, Javier, Ruiz-Mateos, Borja, Bastante, Teresa, Arias, Mercedes, Iglesias-Vázquez, José A., Rodriguez, Maite D., Escalera, Noemí, Acebal, Carlos, Cabrera, José A., Valenciano, Juan, Pérez de Prado, Armando, Fernández-Campos, María J., Casado, Isabel, García-Rubira, Juan C., García-Prieto, Jaime, Sanz-Rosa, David, Cuellas, Carlos, Hernández-Antolín, Rosana, Albarrán, Agustín, Fernández-Vázquez, Felipe, de la Torre-Hernández, José M., Pocock, Stuart, Sanz, Ginés, Fuster, Valentin
Format:	Article
Language:	eng
Subjects:	Adrenergic beta-Antagonists - administration & dosage Adrenergic beta-Antagonists - therapeutic use Antiarythmic agents Biological and medical sciences Biomarkers Blood and lymphatic vessels Cardiology. Vascular system Cardiotonic Agents - administration & dosage Cardiotonic Agents - therapeutic use Cardiovascular system Combined Modality Therapy Coronary heart disease Creatine Kinase, MB Form - blood Diseases of the cardiovascular system Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - therapeutic use Heart Heart Failure - prevention & control Humans Magnetic Resonance Imaging Male Medical sciences Metoprolol - administration & dosage Metoprolol - therapeutic use Middle Aged Myocardial Infarction - drug therapy Myocardial Infarction - pathology Myocardial Infarction - physiopathology Myocardial Infarction - surgery Myocardium - pathology Necrosis Percutaneous Coronary Intervention Pharmacology. Drug treatments Premedication Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Single-Blind Method Stroke Volume - drug effects Thrombolytic Therapy
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Summary:	BACKGROUND—The effect of β-blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). METHODS AND RESULTS—Patients with Killip class II or less anterior ST-segment–elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention within 6 hours of symptoms onset were randomized to receive intravenous metoprolol (n=131) or not (control, n=139) before reperfusion. All patients without contraindications received oral metoprolol within 24 hours. The predefined primary end point was infarct size on magnetic resonance imaging performed 5 to 7 days after STEMI. Magnetic resonance imaging was performed in 220 patients (81%). Mean±SD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.6±15.3 versus 32.0±22.2 g; adjusted difference, −6.52; 95% confidence interval, −11.39 to −1.78; P=0.012). In patients with pre–percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 0 to 1 flow, the adjusted treatment difference in infarct size was −8.13 (95% confidence interval, −13.10 to −3.16; P=0.0024). Infarct size estimated by peak and area under the curve creatine kinase release was measured in all study populations and was significantly reduced by intravenous metoprolol. Left ventricular ejection fraction was higher in the intravenous metoprolol group (adjusted difference, 2.67%; 95% confidence interval, 0.09–5.21; P=0.045). The composite of death, malignant ventricular arrhythmia, cardiogenic shock, atrioventricular block, and reinfarction at 24 hours in the intravenous metoprolol and control groups was 7.1% and 12.3%, respectively (P=0.21). CONCLUSIONS—In patients with anterior Killip class II or less ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01311700. EUDRACT number2010-019939-35.
ISSN:	0009-7322 1524-4539