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Efficacy and safety of out-of-hospital intravenous metoprolol administration in anterior ST-segment elevation acute myocardial infarction: insights from the METOCARD-CNIC trial

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dc.contributor.author Mateos, Alonso
dc.contributor.author García Lunar, Inés
dc.contributor.author García Ruiz, José María
dc.contributor.author Pizarro, Gonzalo
dc.contributor.author Fernández Jiménez, Rodrigo
dc.contributor.author Huertas, Pilar
dc.contributor.author García Álvarez, Ana
dc.contributor.author Fernández-Friera, Leticia
dc.contributor.author Bravo, Jesús
dc.contributor.author Flores Arias, José
dc.contributor.author Barreiro, María V.
dc.contributor.author Chayán Zas, Luisa
dc.contributor.author Corral, Ervigio
dc.contributor.author Fuster, Valentín
dc.contributor.author Sánchez Brunete, Vicente
dc.contributor.author Ibáñez, Borja
dc.date.accessioned 2016-12-20T09:49:24Z
dc.date.available 2016-12-20T09:49:24Z
dc.date.issued 2015
dc.identifier.citation Mateos, A., García-Lunar, I., García-Ruiz, J. M., Pizarro, G., Fernández-Jiménez, R., Huertas, P., ... & Barreiro, M. V. (2015). Efficacy and safety of out-of-hospital intravenous metoprolol administration in anterior ST-segment elevation acute myocardial infarction: insights from the METOCARD-CNIC trial. Annals of emergency medicine, 65(3), 318-324. DOI: 10.1016/j.annemergmed.2014.07.010 spa
dc.identifier.issn 01960644
dc.identifier.uri http://hdl.handle.net/11268/6113
dc.description.abstract We seek to examine the efficacy and safety of prereperfusion emergency medical services (EMS)–administered intravenous metoprolol in anterior ST-segment elevation myocardial infarction patients undergoing eventual primary angioplasty. This is a prespecified subgroup analysis of the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction trial population, who all eventually received oral metoprolol within 12 to 24 hours. We studied patients receiving intravenous metoprolol by EMS and compared them with others treated by EMS but not receiving intravenous metoprolol. Outcomes included infarct size and left ventricular ejection fraction on cardiac magnetic resonance imaging at 1 week, and safety by measuring the incidence of the predefined combined endpoint (composite of death, malignant ventricular arrhythmias, advanced atrioventricular block, cardiogenic shock, or reinfarction) within the first 24 hours. From the total population of the trial (N=270), 147 patients (54%) were recruited during out-of-hospital assistance and transferred to the primary angioplasty center (74 intravenous metoprolol and 73 controls). Infarct size was smaller in patients receiving intravenous metoprolol compared with controls (23.4 [SD 15.0] versus 34.0 [SD 23.7] g; adjusted difference –11.4; 95% confidence interval [CI] –18.6 to –4.3). Left ventricular ejection fraction was higher in the intravenous metoprolol group (48.1% [SD 8.4%] versus 43.1% [SD 10.2%]; adjusted difference 5.0; 95% CI 1.6 to 8.4). Metoprolol administration did not increase the incidence of the prespecified safety combined endpoint: 6.8% versus 17.8% in controls (risk difference –11.1; 95% CI –21.5 to –0.6). Out-of-hospital administration of intravenous metoprolol by EMS within 4.5 hours of symptom onset in our subjects reduced infarct size and improved left ventricular ejection fraction with no excess of adverse events during the first 24 hours. spa
dc.description.sponsorship SIN FINANCIACIÓN spa
dc.language.iso eng spa
dc.title Efficacy and safety of out-of-hospital intravenous metoprolol administration in anterior ST-segment elevation acute myocardial infarction: insights from the METOCARD-CNIC trial spa
dc.type article spa
dc.description.impact 5.008 JCR (2015) Q1, 2/24 Emergency medicine spa
dc.identifier.doi 10.1016/j.annemergmed.2014.07.010
dc.rights.accessRights openAccess spa
dc.subject.uem Infarto de miocardio spa
dc.subject.uem Cardiopatía isquémica spa
dc.subject.unesco Enfermedad cardiovascular spa
dc.description.filiation UEM spa
dc.relation.publisherversion http://dx.doi.org/10.1016/j.annemergmed.2014.07.010 spa
dc.peerreviewed Si spa


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