Infarct Size in STEMI not Affected by Pre-pPCI Metoprolol

Metoprolol cut incidence of malignant arrhythmias; was not linked to increase in adverse events
Metoprolol cut incidence of malignant arrhythmias; was not linked to increase in adverse events

HealthDay News — Early intravenous metoprolol before primary percutaneous coronary intervention (pPCI) does not reduce infarct size in a population with ST-segment elevation myocardial infarction (STEMI), according to a study published online April 3 in the Journal of the American College of Cardiology. The research is being published to coincide with the annual meeting of the American College of Cardiology, held from April 2 to 4 in Chicago.

Vincent Roolvink, MD, from Isala Hospital in Zwolle, Netherlands, and colleagues randomized 683 patients with STEMI presenting <12 hours from symptom onset to intravenous metoprolol (336 patients) or matched placebo (346 patients) before pPCI. Overall, 54.8% of the patients underwent magnetic resonance imaging (MRI).

The researchers found that the infarct size did not differ between the metoprolol and placebo groups (P = 0.616). There was no between-group difference noted in the peak and area under the creatine kinase curve. The left ventricular ejection fraction, assessed by MRI, was similar between the groups (P=0.68). Malignant arrhythmias occurred in 3.6 and 6.9% of the metoprolol and placebo groups, respectively (P=0.050). There was no between-group difference noted in the incidence of adverse events.

"Early intravenous metoprolol before pPCI, was not associated with a reduction in infarct size," the authors write. "Metoprolol reduced the incidence of malignant arrhythmias in the acute phase and was not associated with an increase in adverse events."

The Early-Beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction (Early-BAMI) trial was partially funded by Medtronic. The QMass software was partially supported by a scientific collaboration between CNIC and Medis.

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