TY - JOUR A1 - Roolvink, Vincent AU - Ibáñez, Borja AU - Ottervanger, Jan Paul AU - Pizarro, Gonzalo AU - Van Royen, Niels AU - Mateos, Alonso AU - Dambrink, Jan-Henk E. AU - Escalera, Noemí AU - Lipsic, Erik AU - Albarrán, Agustín AU - Fernández-Ortiz, Antonio AU - Fernández-Avilés, Francisco AU - Goicolea, Francisco Javier AU - Botas, Javier AU - Remkes, Wouter AU - Hernández Jaras, Victoria AU - Kedhi, Elvin T1 - Early intravenous beta-blockers in patients with ST-segment elevation myocardial infarction before primary percutaneous coronary intervention Y1 - 2016 SN - 07351097 UR - http://hdl.handle.net/11268/6025 AB - The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing the effect of early IV beta-blockers before PPCI in a general ST-segment elevation myocardial infarction (STEMI) population. STEMI patients presenting <12 h from symptom onset in Killip class I to II without atrioventricular block were randomized 1:1 to IV metoprolol (2 × 5-mg bolus) or matched placebo before PPCI. Primary endpoint was myocardial infarct size as assessed by cardiac magnetic resonance imaging (CMR) at 30 days. Secondary endpoints were enzymatic infarct size and incidence of ventricular arrhythmias. Safety endpoints included symptomatic bradycardia, symptomatic hypotension, and cardiogenic shock. A total of 683 patients (mean age 62 ± 12 years; 75% male) were randomized to metoprolol (n = 336) or placebo (n = 346). CMR was performed in 342 patients (54.8%). Infarct size (percent of left ventricle [LV]) by CMR did not differ between the metoprolol (15.3 ± 11.0%) and placebo groups (14.9 ± 11.5%; p = 0.616). Peak and area under the creatine kinase curve did not differ between both groups. LV ejection fraction by CMR was 51.0 ± 10.9% in the metoprolol group and 51.6 ± 10.8% in the placebo group (p = 0.68). The incidence of malignant arrhythmias was 3.6% in the metoprolol group versus 6.9% in placebo (p = 0.050). The incidence of adverse events was not different between groups. In a nonrestricted STEMI population, early intravenous metoprolol before PPCI was not associated with a reduction in infarct size. Metoprolol reduced the incidence of malignant arrhythmias in the acute phase and was not associated with an increase in adverse events. KW - Infarto de miocardio KW - Insuficiencia cardíaca KW - Paro cardiaco KW - Enfermedad cardiovascular KW - Sistema cardiovascular LA - eng ER -