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Circulation. 2013 Oct 1;128(14):1495-503. doi: 10.1161/CIRCULATIONAHA.113.003653. Epub 2013 Sep 3.

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.

Author information

1
From Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (B.I., G.P., L.F.-F., A.M., A.F.-O., J.M.G.-R., A.G.-A., J.J.B., P.L.-R., R.F.-J., M.D.R., N.E., J.G.-P., D.S.-R., S.P., G.S., V.F.); Hospital Clínico San Carlos-IdISSC, Madrid, Spain (B.I., C.M., A.F.-O., R.F.-J., B.R.-M., C.A., J.C.G.-R., R.H.-A.); Servicio de Urgencia Médica de Madrid (SUMMA 112), Madrid, Spain (V.S.-B., A.M., J.V., M.J.F.-C.); Hospital Universitario Quirón, Madrid, Spain (G.P., J.A.C.); Complejo Hospitalario Universitario de Vigo-Meixoeiro, Pontevedra, Spain (A.I., M.A.); Hospital Universitario de la Princesa, Madrid, Spain (J.J.-B., T.B.); Hospital Universitario Puerta de Hierro, Madrid, Spain (J.G.); Servicio de Emergencia Medica 061 de Galicia-Sur, Galicia, Spain (J.A.I.-V.); Hospital Universitario León, León, Spain (A.P.d.P., C.C., F.F.-V.); Servicio de Atención Médica Urgente (SAMUR)-Protección Civil, Madrid, Spain (I.C.); Hospital Universitario Doce de Octubre, Madrid, Spain (A.A.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.M.d.l.T.-H.); London School of Hygiene & Tropical Medicine, London, UK (S.P.); and the Zena and Michael A. Wiener CVI, Mount Sinai School of Medicine, New York, NY (V.F.).

Abstract

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 URL:

http://www.clinicaltrials.gov. Unique identifier: NCT01311700. EUDRACT number: 2010-019939-35.

KEYWORDS:

adrenergic beta-antagonist; infarction; magnetic resonance imaging; metoprolol; myocardial infarction; percutaneous coronary intervention; reperfusion injury

[Indexed for MEDLINE]

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