MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor ut, Budapest 1122, Hungary.
MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor ut, Budapest 1122, Hungary.
J Cardiovasc Comput Tomogr. 2015 Mar-Apr;9(2):139-45. doi: 10.1016/j.jcct.2015.02.001. Epub 2015 Feb 14.
Coronary CT angiography (CTA) is an established tool to rule out coronary artery disease. Performance of coronary CTA is highly dependent on patients' heart rates (HRs). Despite widespread use of β-blockers for coronary CTA, few studies have compared various agents used to achieve adequate HR control.
We sought to assess if the ultrashort-acting β-blocker intravenous esmolol is at least as efficacious as the standard of care intravenous metoprolol for HR control during coronary CTA.
Patients referred to coronary CTA with a HR >65 beats/min despite oral metoprolol premedication were enrolled in the study. We studied 412 patients (211 male; mean age, 57 ± 12 years). Two hundred four patients received intravenous esmolol, and 208 received intravenous metoprolol with a stepwise bolus administration protocol. HR and blood pressure were recorded at arrival, before, during, immediately after, and 30 minutes after the coronary CTA scan.
Mean HRs of the esmolol and metoprolol groups were similar at arrival (78 ± 13 beats/min vs 77 ± 12 beats/min; P = .65) and before scan (68 ± 7 beats/min vs 69 ± 7 beats/min; P = .60). However, HR during scan was lower in the esmolol group vs the metoprolol group (58 ± 6 beats/min vs 61 ± 7 beats/min; P < .0001), whereas HRs immediately and 30 minutes after the scan were higher in the esmolol group vs the metoprolol group (68 ± 7 beats/min vs 66 ± 7 beats/min; P = .01 and 65 ± 8 beats/min vs 63 ± 8 beats/min; P < .0001; respectively). HR ≤ 65 beats/min was reached in 182 of 204 patients (89%) who received intravenous esmolol vs 162 of 208 of the patients (78%) who received intravenous metoprolol (P < .05). Of note, hypotension (systolic BP <100 mm Hg) was observed right after the scan in 19 patients (9.3%) in the esmolol group and in 8 patients (3.8%) in the metoprolol group (P < .05), whereas only 5 patients (2.5%) had hypotension 30 minutes after the scan in the esmolol group compared to 8 patients (3.8%) in the metoprolol group (P = .418).
Intravenous esmolol with a stepwise bolus administration protocol is at least as efficacious as the standard of care intravenous metoprolol for HR control in patients who undergo coronary CTA.
冠状动脉 CT 血管造影（CTA）是排除冠状动脉疾病的一种既定工具。冠状动脉 CTA 的性能高度依赖于患者的心率（HR）。尽管β受体阻滞剂广泛用于冠状动脉 CTA，但很少有研究比较用于实现适当 HR 控制的各种药物。
我们旨在评估超短效静脉注射艾司洛尔是否至少与标准护理静脉注射美托洛尔一样有效，用于控制冠状动脉 CTA 期间的 HR。
研究纳入了 HR＞65 次/分且尽管口服美托洛尔预治疗仍未达到要求的接受冠状动脉 CTA 的患者。我们研究了 412 名患者（211 名男性；平均年龄 57±12 岁）。204 名患者接受静脉注射艾司洛尔，208 名患者接受静脉注射美托洛尔，采用逐步推注方案。在到达时、扫描前、扫描期间、扫描后立即和 30 分钟时记录 HR 和血压。
艾司洛尔组和美托洛尔组到达时（78±13 次/分 vs 77±12 次/分；P＝.65）和扫描前（68±7 次/分 vs 69±7 次/分；P＝.60）的平均 HR 相似。然而，扫描期间的 HR 艾司洛尔组低于美托洛尔组（58±6 次/分 vs 61±7 次/分；P＜.0001），而扫描后立即和 30 分钟的 HR 艾司洛尔组高于美托洛尔组（68±7 次/分 vs 66±7 次/分；P＝.01 和 65±8 次/分 vs 63±8 次/分；P＜.0001；分别）。204 名接受静脉注射艾司洛尔的患者中，有 182 名（89%）达到了 HR≤65 次/分，而 208 名接受静脉注射美托洛尔的患者中，有 162 名（78%）达到了 HR≤65 次/分（P＜.05）。值得注意的是，艾司洛尔组中有 19 名患者（9.3%）在扫描后立即出现低血压（收缩压＜100mmHg），而美托洛尔组中有 8 名患者（3.8%）出现低血压（P＜.05），而在艾司洛尔组中，只有 5 名患者（2.5%）在扫描后 30 分钟出现低血压，而美托洛尔组中则有 8 名患者（3.8%）出现低血压（P＝.418）。
在接受冠状动脉 CTA 的患者中，逐步推注方案的静脉注射艾司洛尔在控制 HR 方面至少与标准护理静脉注射美托洛尔一样有效。
