Olsson G, Rehnqvist N, Freyschuss U, Zetterquist S
Department of Medicine, Karolinska Institute, Danderyd, Sweden.
Am J Cardiol. 1988 Mar 1;61(8):519-23. doi: 10.1016/0002-9149(88)90757-6.
The effect of therapy on exercise performance during a 3-year follow-up after acute myocardial infarction (AMI) was evaluated in a double-blind randomized comparison between 154 patients given metoprolol (100 mg twice daily) and 147 patients given placebo. Exercise tests were performed 1.5, 6, 12, 24 and 36 months after AMI. Maximal accomplished workloads were similar in the 2 groups throughout follow-up. Maximal heart rate was significantly higher in the placebo-treated group throughout the study (p less than 0.001). At the 6-week test more patients in the placebo group terminated exercise due to angina pectoris (40 vs 25%, p less than 0.05) and showed exercise-induced ST-depressions (38 vs 27%, p = 0.05) compared with the metoprolol group. Exercise-induced ventricular arrhythmias were significantly more common in the placebo group during the initial 6 months. Death, another AMI or both were significantly reduced by metoprolol treatment in patients with exercise-induced ST depression greater than or equal to 1 mm at the 6-week test. In a multiple logistic regression analysis maximal accomplished workload at 6 weeks (p less than 0.026), male sex (relative risk [rr] = 3.57, p = 0.016), previous AMI (rr = 3.07, p = 0.001), therapy with placebo (rr = 2.14, p = 0.007) and left ventricular failure (rr = 2.04, p = 0.023) were shown to carry independent prognostic information as well as exercise-induced ST-depression (greater than or equal to 1 mm) in placebo-treated patients (rr = 2.70, p = 0.01).
在一项双盲随机对照研究中，对154例服用美托洛尔（每日两次，每次100毫克）的患者和147例服用安慰剂的患者进行了评估，以观察急性心肌梗死（AMI）后3年随访期间治疗对运动表现的影响。在AMI后1.5、6、12、24和36个月进行运动测试。在整个随访期间，两组的最大完成工作量相似。在整个研究过程中，安慰剂治疗组的最大心率显著更高（p<0.001）。在6周测试时，与美托洛尔组相比，安慰剂组更多患者因心绞痛终止运动（40%对25%，p<0.05），且出现运动诱发的ST段压低（38%对27%，p = 0.05）。在最初6个月内，运动诱发的室性心律失常在安慰剂组中明显更常见。在6周测试时运动诱发ST段压低≥1毫米的患者中，美托洛尔治疗显著降低了死亡、再次发生AMI或两者的发生率。在多因素逻辑回归分析中，6周时的最大完成工作量（p<0.026）、男性（相对风险[rr]=3.57，p = 0.016）、既往AMI（rr = 3.07，p = 0.001）、安慰剂治疗（rr = 2.14，p = 0.007）和左心室衰竭（rr = 2.04，p = 0.023）被证明携带独立的预后信息，以及安慰剂治疗患者中运动诱发的ST段压低（≥1毫米）（rr = 2.70，p = 0.01）。
