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Impact of the timing of metoprolol administration during STEMI on infarct size and ventricular function

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dc.contributor.author García Ruiz, José María
dc.contributor.author Fernández Jiménez, Rodrigo
dc.contributor.author García Álvarez, Ana
dc.contributor.author Pizarro, Gonzalo
dc.contributor.author Galán Arriola, Carlos
dc.contributor.author Fernández-Friera, Leticia
dc.contributor.author Mateos, Alonso
dc.contributor.author Nuño Ayala, Mario
dc.contributor.author Agüero, Jaume
dc.contributor.author Sánchez González, Javier
dc.contributor.author García Prieto, Jaime
dc.contributor.author López Melgar, Beatriz
dc.contributor.author Martínez Tenorio, Pedro
dc.contributor.author López Martín, Gonzalo J.
dc.contributor.author Macías, Ángel
dc.contributor.author Pérez Asenjo, Braulio
dc.contributor.author Cabrera Rodríguez, José Ángel
dc.date.accessioned 2016-11-29T11:19:30Z
dc.date.available 2016-11-29T11:19:30Z
dc.date.issued 2016
dc.identifier.citation García-Ruiz, J. M., Fernández-Jiménez, R., García-Alvarez, A., Pizarro, G., Galán-Arriola, C., Fernández-Friera, L., ... & García-Prieto, J. (2016). Impact of the timing of metoprolol administration during STEMI on infarct size and ventricular function. Journal of the American College of Cardiology, 67(18), 2093-2104. DOI: 10.1016/j.jacc.2016.02.050 spa
dc.identifier.issn 07351097
dc.identifier.uri http://hdl.handle.net/11268/6024
dc.description.abstract Pre-reperfusion administration of intravenous (IV) metoprolol reduces infarct size in ST-segment elevation myocardial infarction (STEMI). This study sought to determine how this cardioprotective effect is influenced by the timing of metoprolol therapy having either a long or short metoprolol bolus-to-reperfusion interval. We performed a post hoc analysis of the METOCARD-CNIC (effect of METOprolol of CARDioproteCtioN during an acute myocardial InfarCtion) trial, which randomized anterior STEMI patients to IV metoprolol or control before mechanical reperfusion. Treated patients were divided into short- and long-interval groups, split by the median time from 15 mg metoprolol bolus to reperfusion. We also performed a controlled validation study in 51 pigs subjected to 45 min ischemia/reperfusion. Pigs were allocated to IV metoprolol with a long (−25 min) or short (−5 min) pre-perfusion interval, IV metoprolol post-reperfusion (+60 min), or IV vehicle. Cardiac magnetic resonance (CMR) was performed in the acute and chronic phases in both clinical and experimental settings. For 218 patients (105 receiving IV metoprolol), the median time from 15 mg metoprolol bolus to reperfusion was 53 min. Compared with patients in the short-interval group, those with longer metoprolol exposure had smaller infarcts (22.9 g vs. 28.1 g; p = 0.06) and higher left ventricular ejection fraction (LVEF) (48.3% vs. 43.9%; p = 0.019) on day 5 CMR. These differences occurred despite total ischemic time being significantly longer in the long-interval group (214 min vs. 160 min; p < 0.001). There was no between-group difference in the time from symptom onset to metoprolol bolus. In the animal study, the long-interval group (IV metoprolol 25 min before reperfusion) had the smallest infarcts (day 7 CMR) and highest long-term LVEF (day 45 CMR). In anterior STEMI patients undergoing primary angioplasty, the sooner IV metoprolol is administered in the course of infarction, the smaller the infarct and the higher the LVEF. These hypothesis-generating clinical data are supported by a dedicated experimental large animal study. spa
dc.description.sponsorship SIN FINANCIACIÓN spa
dc.language.iso eng spa
dc.title Impact of the timing of metoprolol administration during STEMI on infarct size and ventricular function spa
dc.type article spa
dc.description.impact 19.896 JCR (2016) Q1, 2/126 Cardiac and Cardiovascular Systems spa
dc.identifier.doi 10.1016/j.jacc.2016.02.050
dc.rights.accessRights openAccess spa
dc.subject.uem Resonancia magnética nuclear (Medicina) spa
dc.subject.uem Infarto de miocardio spa
dc.subject.unesco Enfermedad cardiovascular spa
dc.subject.unesco Sistema cardiovascular spa
dc.description.filiation UEM spa
dc.relation.publisherversion http://dx.doi.org/10.1016/j.jacc.2016.02.050 spa
dc.peerreviewed Si spa


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