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
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
复制标题
DOI：
10.1161/circulationaha.113.003653
复制
发表时间：
2013-10-01
期刊：
影响因子：
37.8
通讯作者：
Fuster, Valentin
中科院分区：
文献类型：
--
作者：
Ibanez, Borja;Macaya, Carlos;Fuster, Valentin
背景-受体阻滞剂与初级经皮冠状动脉介入治疗联合使用时对梗死面积的影响尚不清楚。我们假设美托洛尔在早期给药（再灌注前静脉给药）可减小梗死面积。方法与结果Killip II级及以下st段抬高型心肌梗死（STEMI）患者在症状出现后6小时内行经皮冠状动脉介入治疗，随机分为再灌注前静脉注射美托洛尔（n=131）和不静脉注射美托洛尔（n= 139）两组。所有无禁忌症的患者均在24小时内口服美托洛尔。预先确定的主要终点是STEMI后5至7天进行的磁共振成像的梗死面积。220例（81%）行磁共振成像。与对照组相比，静脉注射美托洛尔后磁共振成像的平均梗死面积更小（25.615.3 g vs 32.0 +/- 22.2 g；调整差值为-6.52；95%可信区间为-11.39 ~ -1.78；P=0.012）。在经皮冠状动脉介入溶栓治疗的0 ~ 1级心肌梗死患者中，调整后的梗死面积治疗差异为-8.13（95%可信区间，-13.10 ~ -3.16；P=0.0024）。在所有研究人群中，通过肌酸激酶释放曲线下的峰值和面积估计梗死面积，静脉注射美托洛尔可显著减少梗死面积。美托洛尔静脉组左室射血分数较高（校正差为2.67%；95%可信区间为0.09 ~ 5.21；P=0.045）。美托洛尔静脉组和对照组24小时死亡、恶性室性心律失常、心源性休克、房室传导阻滞、再梗死的发生率分别为7.1%和12.3% （P=0.21）。结论：Killip前路II级或更低st段抬高型心肌梗死接受原发性经皮冠状动脉介入治疗的患者，再灌注前早期静脉美托洛尔可减小梗死面积，增加左室射血分数，且STEMI后24小时内未发生过多不良事件。
Background The effect of -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%). MeanSD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.615.3 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.