急性心肌梗死后早期预灌注美托洛尔治疗的长期获益：来自 METOCARD-CNIC 试验（急性心肌梗死后美托洛尔在心肌保护中的作用）的结果。
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).
机构信息
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario Quirón-Universidad Europea de Madrid, Madrid, Spain.
Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Montepríncipe, Madrid, Spain.
出版信息
J Am Coll Cardiol. 2014 Jun 10;63(22):2356-62. doi: 10.1016/j.jacc.2014.03.014. Epub 2014 Mar 30.
OBJECTIVES
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.
BACKGROUND
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).
METHODS
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.
RESULTS
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).
CONCLUSIONS
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. (Effect of METOprolol in CARDioproteCtioN During an Acute Myocardial InfarCtion. The METOCARD-CNIC Trial; NCT01311700).
目的
本试验旨在研究再灌注前静脉（IV）美托洛尔给药对左心室（LV）功能和临床事件的长期影响。
背景
在 ST 段抬高型心肌梗死（STEMI）中早期使用 IV 美托洛尔与直接经皮冠状动脉介入治疗（pPCI）联合使用时已被证明可减少梗死面积。
方法
METOCARD-CNIC（急性心肌梗死后美托洛尔在心脏保护中的作用）试验招募了 270 例早期（症状发作后<6 小时）出现前壁 Killip 分级≤II 的前壁 STEMI 患者，并将其随机分为再灌注前 IV 美托洛尔组或对照组。202 例患者（每组 101 例）在 STEMI 后 6 个月进行了长期磁共振成像（MRI）检查。患者进行了最小 12 个月的临床随访。
结果
MRI 检查显示，6 个月时左心室射血分数（LVEF）在 IV 美托洛尔组更高（48.7±9.9%比对照组 45.0±11.7%；调整治疗效果 3.49%；95%置信区间[CI]：0.44%至 6.55%；p=0.025）。6 个月时 LVEF 严重降低（≤35%）的患者在接受 IV 美托洛尔治疗的患者中明显减少（11%比 27%，p=0.006）。在 IV 美托洛尔组中，符合植入式心脏复律除颤器（ICD）I 类适应证的患者比例明显较低（7%比 20%，p=0.012）。在中位随访 2 年时，IV 美托洛尔组的预先指定的死亡、心力衰竭入院、再梗死和恶性心律失常的复合终点发生率为 10.8%，而对照组为 18.3%，调整后的风险比（HR）为 0.55；95%CI：0.26 至 1.04；p=0.065。心力衰竭入院率在 IV 美托洛尔组明显降低（HR：0.32；95%CI：0.015 至 0.95；p=0.046）。
结论
在前壁 Killip 分级≤II 的 STEMI 患者中接受 pPCI 治疗时，再灌注前早期 IV 美托洛尔可导致长期 LVEF 更高、严重 LV 收缩功能障碍和 ICD 适应证发生率降低、心力衰竭入院率降低。（急性心肌梗死后美托洛尔的心脏保护作用。METOCARD-CNIC 试验；NCT01311700）。
Zotero 插件