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Long-term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: Results from the Metocard-CNIC trial (Effect of Metoprolol in Cardioprotection during an Acute Myocardial Infarction)

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dc.contributor.author Pizarro, Gonzalo
dc.contributor.author García Lunar, Inés
dc.contributor.author Martínez de Vega, Vicente
dc.contributor.author Cabrera Rodríguez, José Ángel
dc.date.accessioned 2016-11-29T09:53:32Z
dc.date.available 2016-11-29T09:53:32Z
dc.date.issued 2014
dc.identifier.citation Pizarro, G., Fernández-Friera, L., Fuster, V., Fernández-Jiménez, R., García-Ruiz, J. M., García-Álvarez, A., ... & de Miguel, A. (2014). Long-term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: results from the METOCARD-CNIC trial (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction). Journal of the American College of Cardiology, 63(22), 2356-2362. DOI: 10.1016/j.jacc.2014.03.014 spa
dc.identifier.issn 07351097
dc.identifier.uri http://hdl.handle.net/11268/6020
dc.description.abstract The goal of this trial was to study the long-term effects of intravenous (IV) metoprolol administration before reperfusion on left ventricular (LV) function and clinical events. Early IV metoprolol during ST-segment elevation myocardial infarction (STEMI) has been shown to reduce infarct size when used in conjunction with primary percutaneous coronary intervention (pPCI). The METOCARD-CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial recruited 270 patients with Killip class ≤II anterior STEMI presenting early after symptom onset (<6 h) and randomized them to pre-reperfusion IV metoprolol or control group. Long-term magnetic resonance imaging (MRI) was performed on 202 patients (101 per group) 6 months after STEMI. Patients had a minimal 12-month clinical follow-up. Left ventricular ejection fraction (LVEF) at the 6 months MRI was higher after IV metoprolol (48.7 ± 9.9% vs. 45.0 ± 11.7% in control subjects; adjusted treatment effect 3.49%; 95% confidence interval [CI]: 0.44% to 6.55%; p = 0.025). The occurrence of severely depressed LVEF (≤35%) at 6 months was significantly lower in patients treated with IV metoprolol (11% vs. 27%, p = 0.006). The proportion of patients fulfilling Class I indications for an implantable cardioverter-defibrillator (ICD) was significantly lower in the IV metoprolol group (7% vs. 20%, p = 0.012). At a median follow-up of 2 years, occurrence of the pre-specified composite of death, heart failure admission, reinfarction, and malignant arrhythmias was 10.8% in the IV metoprolol group versus 18.3% in the control group, adjusted hazard ratio (HR): 0.55; 95% CI: 0.26 to 1.04; p = 0.065. Heart failure admission was significantly lower in the IV metoprolol group (HR: 0.32; 95% CI: 0.015 to 0.95; p = 0.046). In patients with anterior Killip class ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer heart failure admissions. spa
dc.description.sponsorship SIN FINANCIACIÓN spa
dc.language.iso eng spa
dc.title Long-term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: Results from the Metocard-CNIC trial (Effect of Metoprolol in Cardioprotection during an Acute Myocardial Infarction) spa
dc.type article spa
dc.description.impact 16.503 JCR (2014) Q1, 1/123 Cardiac and cardiovascular systems spa
dc.identifier.doi 10.1016/j.jacc.2014.03.014
dc.rights.accessRights openAccess spa
dc.subject.uem Infarto de miocardio spa
dc.subject.uem Insuficiencia cardíaca spa
dc.subject.uem Paro cardiaco spa
dc.subject.unesco Sistema cardiovascular spa
dc.subject.unesco Enfermedad cardiovascular spa
dc.description.filiation UEM spa
dc.relation.publisherversion http://dx.doi.org/10.1016/j.jacc.2014.03.014 spa
dc.peerreviewed Si spa


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