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Motawea KR, Gaber H, Singh RB, Swed S, Elshenawy S, Talat NE, Elgabrty N, Shoib S, Wahsh EA, Chébl P, Reyad SM, Rozan SS, Aiash H. Effect of early metoprolol before PCI in ST-segment elevation myocardial infarction on infarct size and left ventricular ejection fraction. A systematic review and meta-analysis of clinical trials. Clin Cardiol 2022; 45:1011-1028. [PMID: 36040709 PMCID: PMC9574721 DOI: 10.1002/clc.23894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 11/15/2022] Open
Abstract
Aim This meta‐analysis aims to look at the impact of early intravenous Metoprolol in ST‐segment elevation myocardial infarction (STEMI) before percutaneous coronary intervention (PCI) on infarct size, as measured by cardio magnetic resonance (CMR) and left ventricular ejection fraction. Methods We searched the following databases: PubMed, Scopus, Cochrane library, and Web of Science. We included only randomized control trials that reported the use of early intravenous Metoprolol in STEMI before PCI on infarct size, as measured by CMR and left ventricular ejection fraction. RevMan software 5.4 was used for performing the analysis. Results Following a literature search, 340 publications were found. Finally, 18 studies were included for the systematic review, and 8 clinical trials were included in the meta‐analysis after the full‐text screening. At 6 months, the pooled effect revealed a statistically significant association between Metoprolol and increased left ventricular ejection fraction (LVEF) (%) compared to controls (mean difference [MD] = 3.57, [95% confidence interval [CI] = 2.22–4.92], p < .00001), as well as decreased infarcted myocardium(g) compared to controls (MD = −3.84, [95% [CI] = −5.75 to −1.93], p < .0001). At 1 week, the pooled effect revealed a statistically significant association between Metoprolol and increased LVEF (%) compared to controls (MD = 2.98, [95% CI = 1.26−4.69], p = .0007), as well as decreased infarcted myocardium(%) compared to controls (MD = −3.21, [95% CI = −5.24 to −1.18], p = .002). Conclusion A significant decrease in myocardial infarction and increase in LVEF (%) was linked to receiving Metoprolol at 1 week and 6‐month follow‐up.
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Affiliation(s)
- Karam R Motawea
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hamed Gaber
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ravi B Singh
- Department of Internal Medicine, Suny Upstate Medical university, Syracuse, New York, USA
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Salem Elshenawy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Nawal Elgabrty
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sheikh Shoib
- Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, Jammu and Kashmir, India
| | - Engy A Wahsh
- Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 university, Giza, Egypt
| | - Pensée Chébl
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sarraa M Reyad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samah S Rozan
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hani Aiash
- Department of Cardiovascular perfusion, Upstate Medical University, Syracuse, New York, USA
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Kahraman F, Arslan A, Dogan A, Turker Y, Guler S. Effect of prior beta-blocker use on in-hospital atrial fibrillation development in patients with ST-elevation myocardial infarction. Clin Exp Hypertens 2022; 44:263-267. [DOI: 10.1080/10641963.2022.2029473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Fatih Kahraman
- Cardiology Clinic, Evliya Celebi Research and Training Hospital, Kutahya, Turkey
| | - Akif Arslan
- Cardiology Clinic, Private Anatolia Hospital, Antalya, Turkey
| | - Abdullah Dogan
- Cardiology Clinic, Private Alfa Medical Center, İzmir, Turkey
| | - Yasin Turker
- Cardiology Clinic, Private Meddem Hospital, Ispart, Turkey
| | - Serdar Guler
- Cardiology Clinic, Acıpayam State Hospital, Denizli, Turkey
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3
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Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. [2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.]. Eur Heart J 2018; 39:119-177. [PMID: 29457615 DOI: 10.1093/eurheartj/ehx393] [Citation(s) in RCA: 6014] [Impact Index Per Article: 1002.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Borja Ibanez
- Department of Cardiology, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
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4
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Bates ER. Intravenous beta-blockers in patients with ST-elevation myocardial infarction treated with primary PCI. EUROINTERVENTION 2017; 13:e149-e151. [PMID: 28579557 DOI: 10.4244/eijv13i2a21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eric R Bates
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
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5
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Agarwal M, Agrawal S, Garg L, Garg A, Bhatia N, Kadaria D, Reed G. Effect of Chronic Obstructive Pulmonary Disease on In-Hospital Mortality and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017; 119:1555-1559. [PMID: 28390680 DOI: 10.1016/j.amjcard.2017.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
There is controversy regarding in-hospital mortality, revascularization, and other adverse outcomes in patients with ST-segment elevation (STEMI) and chronic obstructive pulmonary disease (COPD). We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients aged ≥18 years with a primary diagnosis of STEMI. Univariate and multivariate analyses were performed to evaluate the association of COPD with in-hospital clinical outcomes. Patients with COPD comprised 13.2% of 2,120,005 patients with STEMI. COPD was associated with older age, Medicare insurance, greater co-morbidities, and lower socioeconomic status. Compared with non-COPD patients, patients with COPD had higher inpatient mortality even after adjustment for multiple potential other factors (12.5% vs 8.6%, adjusted odds ratio [AOR] 1.13, 95% CI 1.11 to 1.15, p <0.001). Patients with COPD were more likely to develop new-onset heart failure (AOR 2.01, 95% CI 1.99 to 2.03), cardiogenic shock (AOR 1.24, 95% CI 1.22 to 1.26), and acute respiratory failure (AOR 2.46, 95% CI 2.43 to 2.50) during their hospital stay. Patients with COPD were less likely to undergo diagnostic angiographies and any revascularization procedures. The mean length of stay (6.0 vs 4.6 days; p <0.001) was greater in patients with COPD, as were hospital average hospital charges ($63,956 vs $58,536; p <0.001). In conclusion, among patients with STEMI, COPD is associated with a greater risk of in-hospital mortality, new-onset heart failure, acute respiratory failure, and cardiogenic shock.
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6
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Role of Optimal Medication Given to Patients with Hypertension and Ischemic Heart Disease Prior to an Acute Coronary Syndrome. Heart Int 2017; 12:10.5301_heartint.5000237. [PMID: 30263100 PMCID: PMC6159667 DOI: 10.5301/heartint.5000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Administering optimal cardiovascular medication (OCM) to patients with
hypertension (HBP) and ischemic heart disease (IHD) lowers cardiovascular
morbidity and mortality. The main objective of this study was to compare in-hospital cardiac mortality
among patients with HBP and/or IHD, treated or untreated with OCM, who
developed a first episode of acute coronary syndrome (ACS). Methods The study was carried out retrospectively and included patients admitted with
a first episode of ACS between 2013 and 2016. The patients were divided into
three groups: those with HBP, IHD, and a history of HBP + IHD. Patients were
then divided into two subgroups: subgroup A consisted of patients undergoing
optimal anti-ischemic and/or antihypertensive therapy, while subgroup B
consisted of patients without OCM. Results This analysis comprised 1096 patients. Mean age was 64.3 ± 18 years. There
were 581 patients in subgroup A – 53%, and 515 patients in subgroup B – 47%.
Total cardiac mortality was 9.98%, different depending on the groups and
subgroups studied: HBP group total – 7%, subgroup A – 5.1%, significantly
lower compared to subgroup B – 9.4% (p = 0.05); IHD group total – 12.2%,
subgroup A – 9.07%, significantly lower compared to subgroup B – 15.8% (p =
0.05); HBP + IHD group total – 14.35%, subgroup A – 9.9%, significantly
lower compared to subgroup B – 18.8% (p = 0.05). Conclusions The lack of OCM in patients with HBP and/or IHD is correlated to a
significant increase in in-hospital cardiac mortality among patients who
develop a first-episode ACS.
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Elgendy IY, Elgendy AY, Mahmoud AN, Mansoor H, Mojadidi MK, Bavry AA. Intravenous β-blockers for patients undergoing primary percutaneous coronary intervention: A meta-analysis of randomized trials. Int J Cardiol 2016; 223:891-897. [DOI: 10.1016/j.ijcard.2016.08.293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/18/2016] [Indexed: 01/03/2023]
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8
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Aşkın L, Karakelleoğlu Ş, Değirmenci H, Demirelli S, Şimşek Z, Taş MH, Topçu S, Lazoğlu Z. Comparison of the effects of metoprolol or carvedilol on serum gamma-glutamyltransferase and uric acid levels among patients with acute coronary syndrome without ST segment elevation. Anatol J Cardiol 2015; 16:16-22. [PMID: 26467358 PMCID: PMC5336699 DOI: 10.5152/akd.2015.5708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective: Serum gamma-glutamyltransferase (GGT) and uric acid levels measured in patients with acute coronary syndrome without ST segment elevation (NSTEMI) are important in diagnosis and in predicting the prognosis of the disease. There is a limited number of clinical studies investigating the effects of beta-blockers on GGT and uric acid levels in these patients. In our study, we aimed to investigate the effects of beta-blocker therapy on GGT and uric acid levels. Methods: We conducted a randomized, prospective clinical study. Hundred patients with NSTEMI were included in this study, and they were divided into two groups. Fifty patients were administered metoprolol succinate treatment (1 × 50 mg), whereas the remaining 50 patients were administered carvedilol treatment (2 × 12.5 mg). Thereafter, all of the patients underwent coronary angiography. Blood samples were taken at the time of admission, at the 1st month, and 3rd month to detect GGT and uric acid levels. Results: There was no statistically significant difference among the metoprolol or carvedilol groups in terms of the GGT levels measured at the baseline, 1st month, and 3rd month (p=0.904 and p=0.573, respectively). In addition, there was no statistically significant difference among the metoprolol or carvedilol groups in terms of uric acid levels measured at the baseline, 1st month, and 3rd month (p=0.601 and p=0.601, respectively). Conclusion: We found that GGT and uric acid levels did not show any change compared to the baseline values, with metoprolol and carvedilol treatment initiated in the early period in patients with NSTEMI.
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Affiliation(s)
- Lütfü Aşkın
- Department of Cardiology, Faculty of Medicine, Atatürk University; Erzurum-Turkey.
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9
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Garcia-Rubira JC, Almendro-Delia M, Calvo-Taracido M, Blanco-Ponce E, Bastos-Amador P, Reina-Toral A, Calvo-Jambrina R, Cruz-Fernández JM, Garcia-Alcántara A, Hidalgo-Urbano R. Influence of the previous use of β-blockers on the early clinical course of acute coronary syndromes. Intern Emerg Med 2015; 10:831-7. [PMID: 25990485 DOI: 10.1007/s11739-015-1251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
Recent studies have recently questioned the current role of β-blockers in myocardial infarction. Our purpose is to analyze the influence of the previous use of β-blockers on the early course of patients admitted because of acute coronary syndrome (ACS). We analyzed the data of 37.359 patients included in the ARIAM-Andalucia Registry. Of them, 7759 (20.8%) were previously receiving β-blockers. BB patients were older, more often female, had more risk factors and vascular disease, and less often had an ST-elevation myocardial infarction. In the unadjusted analysis, BB patients less often had ventricular fibrillation or atrioventricular block, and more often a Killip classification >1, and no difference of in-hospital mortality (5.7 vs 5.6%). After logistic regression analysis and propensity score matching, no differences in complications or mortality (odds ratio 0.997, 95% confidence interval 0.882-1.128) were found in relationship to previous β-blockers. In conclusion, we find that the previous administration of β-blockers is not an independent predictor of the early prognosis of ACS.
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Affiliation(s)
- Juan Carlos Garcia-Rubira
- Unidad Coronaria, Cardiology Department, Virgen Macarena University Hospital, Avenida Dr Fedriani, sn, E41008, Seville, Spain.
| | - Manuel Almendro-Delia
- Unidad Coronaria, Cardiology Department, Virgen Macarena University Hospital, Avenida Dr Fedriani, sn, E41008, Seville, Spain
| | - Manuel Calvo-Taracido
- Unidad Coronaria, Cardiology Department, Virgen Macarena University Hospital, Avenida Dr Fedriani, sn, E41008, Seville, Spain
| | - Emilia Blanco-Ponce
- Unidad Coronaria, Cardiology Department, Virgen Macarena University Hospital, Avenida Dr Fedriani, sn, E41008, Seville, Spain
| | - Pablo Bastos-Amador
- Unidad Coronaria, Cardiology Department, Virgen Macarena University Hospital, Avenida Dr Fedriani, sn, E41008, Seville, Spain
| | | | - Roman Calvo-Jambrina
- Unidad Coronaria, Cardiology Department, Virgen Macarena University Hospital, Avenida Dr Fedriani, sn, E41008, Seville, Spain
| | - José Maria Cruz-Fernández
- Unidad Coronaria, Cardiology Department, Virgen Macarena University Hospital, Avenida Dr Fedriani, sn, E41008, Seville, Spain
| | | | - Rafael Hidalgo-Urbano
- Unidad Coronaria, Cardiology Department, Virgen Macarena University Hospital, Avenida Dr Fedriani, sn, E41008, Seville, Spain
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10
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Lin TT, Arnold Chan K, Chen HM, Lai CL, Lai MS. Class effect of beta-blockers in survivors of ST-elevation myocardial infarction: A nationwide cohort study using an insurance claims database. Sci Rep 2015; 5:13692. [PMID: 26328923 PMCID: PMC4642576 DOI: 10.1038/srep13692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/03/2015] [Indexed: 11/10/2022] Open
Abstract
Beta-blockers can help reduce mortality following acute myocardial infarction (MI); however, whether beta-blockers exert a class effect remains controversial. This study identified all patients with first ST-elevation MI for the period of 2003 to 2010 from the National Health Insurance claims database, Taiwan. We compared patients prescribed carvedilol, bisoprolol, and propranolol. Study outcomes included all-cause death, cardiovascular death, and recurrence of MI. The propensity scores were constructed using multinomial logistic regression to model the receipt of different beta-blockers. Treating carvedilol group as a reference, we employed a simultaneous three-group comparison approach using the Cox regression model with adjustment for the propensity scores to compare the relative risks of various outcomes. Among the 16836 patients, 7591 were prescribed carvedilol, 5934 bisoprolol, and 3311 propranolol. Mean follow-up time was one year. After accounting for baseline differences, patients treated with bisoprolol (HR 0.87, 95% CI 0.72–1.05, p = 0.14) or propranolol (HR 1.07, 95% CI 0.84–1.36, p = 0.58) had a similar risk of all-cause death in comparison with carvedilol. No significant differences were observed among three beta-blocker groups with regard to the risks of cardiovascular death and recurrence of MI. Our results suggest that beta-blockers exert a possible class effect in the treatment of acute MI.
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Affiliation(s)
- Ting-Tse Lin
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - K Arnold Chan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ho-Min Chen
- Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Lun Lai
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lai
- Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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11
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Esmolol for tight heart rate control in patients with STEMI: Design and rationale of the beta-blocker in acute myocardial infarction (BEAT-AMI) trial. Int J Cardiol 2015; 190:351-2. [DOI: 10.1016/j.ijcard.2015.04.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 11/21/2022]
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12
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Antoniucci D. Block the Ischemia and Reperfusion Damage. J Am Coll Cardiol 2014; 63:2363-4. [DOI: 10.1016/j.jacc.2014.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/16/2014] [Indexed: 11/28/2022]
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13
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Mortality Trends in Patients Hospitalized with the Initial Acute Myocardial Infarction in a Middle Eastern Country over 20 Years. Cardiol Res Pract 2014; 2014:464323. [PMID: 24868481 PMCID: PMC4020445 DOI: 10.1155/2014/464323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/19/2014] [Accepted: 04/04/2014] [Indexed: 01/09/2023] Open
Abstract
We aimed to define the temporal trend in the initial Acute Myocardial Infarction (AMI) management and outcome during the last two decades in a Middle Eastern country. A total of 10,915 patients were admitted with initial AMI with mean age of 53 ± 11.8 years. Comparing the two decades (1991–2000) to (2001–2010), the use of antiplatelet drugs increased from 84% to 95%, β-blockers increased from 38% to 56%, and angiotensin converting enzyme inhibitors (ACEI) increased from 12% to 36% (P < 0.001 for all). The rates of PCI increased from 2.5% to 14.6% and thrombolytic therapy decreased from 71% to 65% (P < 0.001 for all). While the rate of hospitalization with Initial MI increased from 34% to 66%, and the average length of hospital stay decreased from 6.4 ± 3 to 4.6 ± 3, all hospital outcomes parameters improved significantly including a 39% reduction in in-hospital Mortality. Multivariate logistic regression analysis showed that higher utilization of antiplatelet drugs, β-blockers, and ACEI were the main contributors to better hospital outcomes. Over the study period, there was a significant increase in the hospitalization rate in patients presenting with initial AMI. Evidence-based medical therapies appear to be associated with a substantial improvement in outcome and in-hospital mortality.
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14
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Ibanez B, Macaya C, Sánchez-Brunete V, Pizarro G, Fernández-Friera L, Mateos A, Fernández-Ortiz A, García-Ruiz JM, García-Álvarez A, Iñiguez A, Jiménez-Borreguero J, López-Romero P, Fernández-Jiménez R, Goicolea J, Ruiz-Mateos B, Bastante T, Arias M, Iglesias-Vázquez JA, Rodriguez MD, Escalera N, Acebal C, Cabrera JA, Valenciano J, Pérez de Prado A, Fernández-Campos MJ, Casado I, García-Rubira JC, García-Prieto J, Sanz-Rosa D, Cuellas C, Hernández-Antolín R, Albarrán A, Fernández-Vázquez F, de la Torre-Hernández JM, Pocock S, Sanz G, Fuster V. Effect of early metoprolol on infarct size in ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction (METOCARD-CNIC) trial. Circulation 2013; 128:1495-503. [PMID: 24002794 DOI: 10.1161/circulationaha.113.003653] [Citation(s) in RCA: 281] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The effect of β-blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). METHODS AND RESULTS Patients with Killip class II or less anterior ST-segment-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention within 6 hours of symptoms onset were randomized to receive intravenous metoprolol (n=131) or not (control, n=139) before reperfusion. All patients without contraindications received oral metoprolol within 24 hours. The predefined primary end point was infarct size on magnetic resonance imaging performed 5 to 7 days after STEMI. Magnetic resonance imaging was performed in 220 patients (81%). Mean ± SD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.6 ± 15.3 versus 32.0 ± 22.2 g; adjusted difference, -6.52; 95% confidence interval, -11.39 to -1.78; P=0.012). In patients with pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 0 to 1 flow, the adjusted treatment difference in infarct size was -8.13 (95% confidence interval, -13.10 to -3.16; P=0.0024). Infarct size estimated by peak and area under the curve creatine kinase release was measured in all study populations and was significantly reduced by intravenous metoprolol. Left ventricular ejection fraction was higher in the intravenous metoprolol group (adjusted difference, 2.67%; 95% confidence interval, 0.09-5.21; P=0.045). The composite of death, malignant ventricular arrhythmia, cardiogenic shock, atrioventricular block, and reinfarction at 24 hours in the intravenous metoprolol and control groups was 7.1% and 12.3%, respectively (P=0.21). CONCLUSIONS In patients with anterior Killip class II or less ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01311700. EUDRACT number: 2010-019939-35.
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Affiliation(s)
- Borja Ibanez
- From Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (B.I., G.P., L.F.-F., A.M., A.F.-O., J.M.G.-R., A.G.-A., J.J.B., P.L.-R., R.F.-J., M.D.R., N.E., J.G.-P., D.S.-R., S.P., G.S., V.F.); Hospital Clínico San Carlos-IdISSC, Madrid, Spain (B.I., C.M., A.F.-O., R.F.-J., B.R.-M., C.A., J.C.G.-R., R.H.-A.); Servicio de Urgencia Médica de Madrid (SUMMA 112), Madrid, Spain (V.S.-B., A.M., J.V., M.J.F.-C.); Hospital Universitario Quirón, Madrid, Spain (G.P., J.A.C.); Complejo Hospitalario Universitario de Vigo-Meixoeiro, Pontevedra, Spain (A.I., M.A.); Hospital Universitario de la Princesa, Madrid, Spain (J.J.-B., T.B.); Hospital Universitario Puerta de Hierro, Madrid, Spain (J.G.); Servicio de Emergencia Medica 061 de Galicia-Sur, Galicia, Spain (J.A.I.-V.); Hospital Universitario León, León, Spain (A.P.d.P., C.C., F.F.-V.); Servicio de Atención Médica Urgente (SAMUR)-Protección Civil, Madrid, Spain (I.C.); Hospital Universitario Doce de Octubre, Madrid, Spain (A.A.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.M.d.l.T.-H.); London School of Hygiene & Tropical Medicine, London, UK (S.P.); and the Zena and Michael A. Wiener CVI, Mount Sinai School of Medicine, New York, NY (V.F.)
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Valle JA, Zhang M, Dixon S, Aronow HD, Share D, Naoum JB, Gurm HS. Impact of pre-procedural beta blockade on inpatient mortality in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction. Am J Cardiol 2013; 111:1714-20. [PMID: 23528025 DOI: 10.1016/j.amjcard.2013.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/17/2013] [Accepted: 02/17/2013] [Indexed: 12/25/2022]
Abstract
Early use of β blockers (BBs) in acute myocardial infarction remains controversial, with some studies demonstrating benefit and others harm. The aim of this study was to assess the association between pre-percutaneous coronary intervention (PCI) BB use and in-hospital outcomes in patients who underwent primary PCI for ST-segment elevation myocardial infarction between 2007 and 2009 at institutions participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC-2). Inverse propensity score weighting was used to account for the nonrandomized use of pre-PCI BBs. The cohort comprised 7,667 patients, with 4,769 (62%) receiving pre-PCI BBs. These patients were older, with higher rates of diabetes mellitus, hypertension, and previous myocardial infarction, PCI, or coronary artery bypass grafting. In adjusted models, pre-PCI BB use was associated with lower rates of intraprocedural ventricular tachycardia or ventricular fibrillation (odds ratio [OR] 0.58, p <0.01) and lower in-hospital mortality (OR 0.65, p = 0.022), with increases in rates of emergent coronary artery bypass grafting (OR 1.56, p <0.01) and repeat PCI (OR 1.93, p <0.01). There were no significant increases in rates of cardiogenic shock and congestive heart failure. In conclusion, pre-PCI BB use in this population was associated with decreased arrhythmia and mortality, without increasing rates of cardiogenic shock and heart failure but with higher rates of repeat PCI and emergent coronary artery bypass grafting, suggesting that there may yet remain a role for early BB use in pre-PCI patients with ST-segment elevation myocardial infarctions.
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Affiliation(s)
- Javier A Valle
- Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA
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Benefit of Immediate Beta-Blocker Therapy on Mortality in Patients With ST-Segment Elevation Myocardial Infarction*. Crit Care Med 2013; 41:1396-404. [DOI: 10.1097/ccm.0b013e31827caa64] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Kezerashvili A, Marzo K, De Leon J. Beta blocker use after acute myocardial infarction in the patient with normal systolic function: when is it "ok" to discontinue? Curr Cardiol Rev 2013; 8:77-84. [PMID: 22845818 PMCID: PMC3394111 DOI: 10.2174/157340312801215764] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 05/04/2012] [Accepted: 05/04/2012] [Indexed: 01/12/2023] Open
Abstract
Beta-Blockers [BB] have been used extensively in the last 40 years after acute myocardial infarction [AMI] as part of therapy and in secondary prevention. The evidence for “routine” therapy with beta-blocker use post AMI rests largely on results of trials conducted over 25 years ago. However, there remains no clear recommendation regarding the appropriate duration of treatment with BBs in post AMI patients with normal left ventricular ejection fraction [LVEF] who are not experiencing angina, or who require BB for hypertension or dysrhythmia. Based on the latest ACC/AHA guidelines, BBs are recommended for early use in the setting of AMI, except in patients who are at low risk and then indefinitely as secondary prevention after AMI. This recommendation was downgraded to class IIa in low risk patients and the updated 2007 ACC/AHA guidelines suggest that the rationale for BB for secondary prevention is from limited data derived from extrapolations of chronic angina and heart failure trials. In this review, we examine the key trials that have shaped the current guidelines and recommendations. In addition, we attempt to answer the question of the duration of BB use in patients with preserved LVEF after acute MI, as well as which subgroups of patients benefits most from post AMI use of beta blockers.
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Affiliation(s)
- Anna Kezerashvili
- Department of Medicine, Cardiology Division, Winthrop University Hospital, Mineola, NY, USA.
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Early intravenous beta-blockers in patients with acute coronary syndrome--a meta-analysis of randomized trials. Int J Cardiol 2012; 168:915-21. [PMID: 23168009 DOI: 10.1016/j.ijcard.2012.10.050] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 10/09/2012] [Accepted: 10/28/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intravenous (IV) beta-blockade is currently a Class IIa recommendation in early management of patients with acute coronary syndromes (ACS) without obvious contraindications. METHODS We searched the PubMed, EMBASE and the Cochrane Register for Controlled Clinical Trials for randomized clinical trials from 1965 through December, 2011, comparing intravenous beta-blockers administered within 12 hours of presentation of ACS with standard medical therapy and/or placebo. The primary outcome assessed was the risk of short-term (in-hospital mortality-with maximum follow up duration of 90 days) all-cause mortality in the intervention group versus the comparator group. The secondary outcomes assessed were ventricular tachyarrhythmias, myocardial reinfarction, cardiogenic shock, and stroke. Pooled treatment effects were estimated using relative risk with Mantel-Haenszel risk ratio, using a random-effects model. RESULTS Sixteen studies enrolling 73,396 participants met the inclusion ⁄ exclusion criteria. In- hospital mortality was reduced 8% with intravenous beta-blockers, RR=0.92 (95% CI, 0.86-1.00; p=0.04) when compared with controls. Moreover, intravenous beta-blockade reduced the risk of ventricular tachyarrhythmias (RR=0.61; 95 % CI 0.47-0.79; p=0.0003) and myocardial reinfarction (RR=0.73, 95 % CI 0.59-0.91; p=0.004) without increase in the risk of cardiogenic shock, (RR=1.02; 95% CI 0.77-1.35; p=0.91) or stroke (RR=0.58; 95 % CI 0.17-1.98; p=0.38). CONCLUSIONS Intravenous beta-blockers early in the course of appropriate patients with ACS appears to be associated with significant reduction in the risk of short-term cardiovascular outcomes, including a reduction in the risk of all-cause mortality.
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Ibanez B, Fuster V, Macaya C, Sánchez-Brunete V, Pizarro G, López-Romero P, Mateos A, Jiménez-Borreguero J, Fernández-Ortiz A, Sanz G, Fernández-Friera L, Corral E, Barreiro MV, Ruiz-Mateos B, Goicolea J, Hernández-Antolín R, Acebal C, García-Rubira JC, Albarrán A, Zamorano JL, Casado I, Valenciano J, Fernández-Vázquez F, de la Torre JM, Pérez de Prado A, Iglesias-Vázquez JA, Martínez-Tenorio P, Iñiguez A. Study design for the "effect of METOprolol in CARDioproteCtioN during an acute myocardial InfarCtion" (METOCARD-CNIC): a randomized, controlled parallel-group, observer-blinded clinical trial of early pre-reperfusion metoprolol administration in ST-segment elevation myocardial infarction. Am Heart J 2012; 164:473-480.e5. [PMID: 23067904 DOI: 10.1016/j.ahj.2012.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Infarct size predicts post-infarction mortality. Oral β-blockade within 24 hours of a ST-segment elevation acute myocardial infarction (STEMI) is a class-IA indication, however early intravenous (IV) β-blockers initiation is not encouraged. In recent magnetic resonance imaging (MRI)-based experimental studies, the β(1)-blocker metoprolol has been shown to reduce infarct size only when administered before coronary reperfusion. To date, there is not a single trial comparing the pre- vs. post-reperfusion β-blocker initiation in STEMI. OBJECTIVE The METOCARD-CNIC trial is testing whether the early initiation of IV metoprolol before primary percutaneous coronary intervention (pPCI) could reduce infarct size and improve outcomes when compared to oral post-pPCI metoprolol initiation. DESIGN The METOCARD-CNIC trial is a randomized parallel-group single-blind (to outcome evaluators) clinical effectiveness trial conducted in 5 Counties across Spain that will enroll 220 participants. Eligible are 18- to 80-year-old patients with anterior STEMI revascularized by pPCI ≤6 hours from symptom onset. Exclusion criteria are Killip-class ≥III, atrioventricular block or active treatment with β-blockers/bronchodilators. Primary end point is infarct size evaluated by MRI 5 to 7 days post-STEMI. Prespecified major secondary end points are salvage-index, left ventricular ejection fraction recovery (day 5-7 to 6 months), the composite of (death/malignant ventricular arrhythmias/reinfarction/admission due to heart failure), and myocardial perfusion. CONCLUSIONS The METOCARD-CNIC trial is testing the hypothesis that the early initiation of IV metoprolol pre-reperfusion reduces infarct size in comparison to initiation of oral metoprolol post-reperfusion. Given the implications of infarct size reduction in STEMI, if positive, this trial might evidence that a refined use of an approved inexpensive drug can improve outcomes of patients with STEMI.
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Yoshiyama M. Effect and safety of landiolol in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Circ J 2012; 76:301-2. [PMID: 22214901 DOI: 10.1253/circj.cj-11-1454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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21
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Hanada K, Higuma T, Nishizaki F, Sukekawa T, Yokota T, Yamada M, Saito S, Kushibiki M, Oikawa K, Abe N, Tomita H, Osanai T, Okumura K. Randomized Study on the Efficacy and Safety of Landiolol, an Ultra-Short-Acting .BETA.1-Adrenergic Blocker, in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Circ J 2012; 76:439-45. [DOI: 10.1253/circj.cj-11-0947] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenji Hanada
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Takumi Higuma
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Fumie Nishizaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Takanori Sukekawa
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Takashi Yokota
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Masahiro Yamada
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Shin Saito
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Motoi Kushibiki
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Koichi Oikawa
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Naoki Abe
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Tomohiro Osanai
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Ken Okumura
- Department of Cardiology, Hirosaki University Graduate School of Medicine
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Ibáñez B, Fuster V, Macaya C, Jiménez-Borreguero J, Iñiguez A, Fernández-Ortiz A, Sanz G, Sánchez-Brunete V. [Modulation of the beta-adrenergic system during acute myocardial infarction: rationale for a new clinical trial]. Rev Esp Cardiol 2011; 64 Suppl 2:28-33. [PMID: 21807284 DOI: 10.1016/j.recesp.2011.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 02/20/2011] [Indexed: 11/19/2022]
Abstract
Acute myocardial infarction is caused by sudden coronary artery occlusion. Persistent ischemia results in necrosis of the myocardial tissue supplied by the occluded vessel. It has recently been shown that the final size of the infarct is a major predictor of future clinical events, and is, therefore, used as a surrogate outcome in clinical trials. Moreover, it has become clear that the duration of ischemia in the main determinant of the success of myocardial salvage (i.e. of non-necrotic at-risk myocardium). In addition to minimizing the time between symptom onset and reperfusion, there is considerable interest in finding therapies that can further limit the size of the infarction (i.e. cardioprotective therapies) and they are the focus of numerous clinical studies. Oral β-blockade within the first few hours of an AMI is a class-IA indication in clinical practice guidelines. However, early intravenous β-blockade, even before coronary artery reperfusion, is not routinely recommended. Preclinical research has demonstrated that the selectiveβ1-blocker metoprolol is able to reduce the infarct size only when administered before coronary artery reperfusion, which indicates that its cardioprotective properties are secondary to its ability to reduce reperfusion injury. In addition, retrospective studies of AMI suggest that starting intravenous β-blockade early has clinical benefits (i.e. lower mortality and better recovery of left ventricular contractility) in patients without contraindications. Our general hypothesis is that early administration of metoprolol (i.e. intravenously before reperfusion) results in smaller infarcts than administering the drug orally after reperfusion. The Effect of METOprolol in CARDioproteCtioN during an acute myocardial InfarCtion (METOCARD-CNIC) trial will test this hypothesis in patients with ST-segment elevation AMI.
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Affiliation(s)
- Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, España.
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23
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Pathak EB, Strom JA. Percutaneous coronary intervention, comorbidities, and mortality among emergency department-admitted ST-elevation myocardial infarction patients in Florida. J Interv Cardiol 2010; 23:205-15. [PMID: 20345503 DOI: 10.1111/j.1540-8183.2010.00541.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Risk of mortality following an ST-elevation myocardial infarction (STEMI) can be significantly reduced by prompt percutaneous coronary intervention (PCI). National guidelines specify primary PCI as the preferred recommended treatment for STEMI. In this study, we examined same-day PCI as an independent predictor of in-hospital mortality, after adjustment for comorbidities, other patient factors, and hospital PCI-volume using unselected surveillance data from Florida. METHODS We analyzed hospital discharge data for adults, 18+ years old, with a primary diagnosis of STEMI who were admitted to PCI-capable hospitals through the emergency department during 2001-2005 (n = 43,849). Hierarchical (multilevel) logistic regression models were used for analysis. RESULTS Overall, 4,143 STEMI patients (9.4%) did not survive to hospital discharge. In late 2005, the in-hospital mortality rates were 1.9% for those who received same-day PCI versus 13.0% for those who did not. After adjustment for multiple patient factors, same-day PCI was a significant predictor of in-hospital survival with a strong protective effect (adjusted OR = 0.35, 95% CI 0.31-0.38 P < 0.0001). Restriction of the analysis to those patients who survived the first day of admission did not appreciably change this result (adjust OR = 0.37, 95% CI 0.33-0.42, P < 0.0001). Hospital PCI-volume did not significantly impact mortality risk. CONCLUSIONS Same-day PCI markedly reduced the risk of in-hospital mortality among STEMI patients after multivariate adjustment. Serious comorbidities and complications, older age, and female gender continued to predict elevated risk of mortality after control for treatment status. Our results provide additional evidence in support of national clinical recommendations and aggressive treatment of STEMI.
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Affiliation(s)
- Elizabeth Barnett Pathak
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, Florida 33612, USA.
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Osmancik PP, Stros P, Herman D. In‐hospital arrhythmias in patients with acute myocardial infarction—the relation to the reperfusion strategy and their prognostic impact. ACTA ACUST UNITED AC 2009; 10:15-25. [DOI: 10.1080/17482940701474478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Arshad A, Mandava A, Kamath G, Musat D. Sudden Cardiac Death and the Role of Medical Therapy. Prog Cardiovasc Dis 2008; 50:420-38. [DOI: 10.1016/j.pcad.2007.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Wienbergen H, Zeymer U, Gitt AK, Juenger C, Schiele R, Heer T, Towae F, Senges J. Prognostic impact of acute beta-blocker therapy on top of aspirin and angiotensin-converting enzyme inhibitor therapy in consecutive patients with ST-elevation acute myocardial infarction. Am J Cardiol 2007; 99:1208-11. [PMID: 17478143 DOI: 10.1016/j.amjcard.2006.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 12/07/2006] [Accepted: 12/07/2006] [Indexed: 01/06/2023]
Abstract
The prognostic effect of beta-blocker treatment on ST-elevation acute myocardial infarction (STEMI) is controversially discussed in the era of reperfusion therapy. From the German multicenter registry Maximal Individual Therapy of Acute Myocardial Infarction PLUS (MITRA PLUS), 17,809 consecutive patients with STEMI treated with a guideline-recommended therapy with aspirin and an angiotensin-converting enzyme inhibitor were investigated; the prognostic effect of additional acute beta-blocker treatment was analyzed. Patients with cardiogenic shock were excluded. Of included patients, 77.6% received additional acute beta-blocker treatment and 22.4% did not. Patients with beta-blocker treatment were younger and more often received reperfusion therapy. Acute beta-blocker treatment was associated with a lower hospital mortality (univariate analysis 4.9% vs 10.8%, p <0.001; multivariate analysis odds ratio [OR] 0.70, 95% confidence interval [CI] 0.61 to 0.81). Acute beta blockade was significantly associated with a lower hospital mortality in patients without (OR 0.66, 95% CI 0.56 to 0.79) and with (OR 0.76, 95% CI 0.60 to 0.98) reperfusion therapy. The greatest benefit of acute beta-blocker treatment, measured by the number needed to treat to save 1 life, was found in patients with anterior MI, a heart rate > or =80 beats/min, no reperfusion therapy, female gender, and age > or =65 years. In conclusion, acute beta-blocker therapy in the clinical practice of treating patients with STEMI, in addition to aspirin and angiotensin-converting enzyme inhibitor therapy, was independently associated with a significant decrease in hospital mortality in patients with and without reperfusion therapy. High-risk patients with STEMI, such as elderly patients and patients without reperfusion therapy, showed a greater benefit of acute beta-blocker therapy than low-risk patients with STEMI.
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Affiliation(s)
- Harm Wienbergen
- Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung, Ludwigshafen, Germany.
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27
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Bode C. Therapie des akuten Myokardinfarkts. Internist (Berl) 2006; 47:764-6. [PMID: 16794823 DOI: 10.1007/s00108-006-1651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C Bode
- Abteilung für Kardiologie und Angiologie, Medizinische Klinik der Universitätsklinik, Hugstetter Strasse 55, 79106, Freiburg.
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Henriques JPS, Gheeraert PJ, Ottervanger JP, de Boer MJ, Dambrink JHE, Gosselink ATM, van 't Hof AWJ, Hoorntje JCA, Suryapranata H, Zijlstra F. Ventricular fibrillation in acute myocardial infarction before and during primary PCI. Int J Cardiol 2006; 105:262-6. [PMID: 16274766 DOI: 10.1016/j.ijcard.2004.12.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Accepted: 12/12/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND There are scarce and sometimes contradictory data about ventricular fibrillation (VF) during the acute phase of MI. In-hospital VF most often occurs with inferior MI, when treated with fibrinolytics. Out-of-hospital VF seems to be associated with anterior MI. We studied characteristics of patients with VF during reperfusion therapy by primary angioplasty (PCI) versus patients with VF before PCI. METHODS From January 1995 until December 2001, we treated 2826 patients for acute MI and reviewed clinical records of all patients who developed VF and classified the patients according to the first episode of VF: either before or during the angioplasty procedure. RESULTS VF developed in 219 (8%) patients. Patients with VF during reperfusion therapy (n=74, 3%) were older (p=0.03), more frequently female (0.04), less often had heart failure (p=0.04), when compared with patient with VF before PCI (n=145, 5%). Patients with VF during PCI experienced more often preinfarction angina (p=0.009) and suffered more often from inferior MI (p=0.001), when compared with patients with VF before PCI. CONCLUSIONS Patients with early VF before reperfusion have different characteristics when compared with patients with VF during reperfusion. Infarct location is a major determinant of timing of VF, when both groups are compared (p<0.001).
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Affiliation(s)
- Jose P S Henriques
- Department of Cardiology, Isala Klinieken, locatie Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands
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29
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Atar I, Korkmaz ME, Atar IA, Gulmez O, Ozin B, Bozbas H, Erol T, Aydinalp A, Yildirir A, Yucel M, Muderrisoglu H. Effects of metoprolol therapy on cardiac troponin-I levels after elective percutaneous coronary interventions. Eur Heart J 2006; 27:547-52. [PMID: 16415095 DOI: 10.1093/eurheartj/ehi709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Beta-blockers (BBs) have been shown to improve survival and reduce the risk of re-infarction in patients following myocardial infarction. There are conflicting data about the effects of BB therapy on cardiac biomarkers after percutaneous coronary interventions (PCIs). The aim of the study was to investigate the effects of BB use on cardiac troponin-I (cTnI) levels in patients who had undergone elective PCI. METHODS AND RESULTS In this prospective study, 287 patients with coronary artery disease were included. Patients were randomized either to BB or control groups prior to the intervention. Blood samples for cTnI were obtained before and at 6, 24, and 36 h after the procedure. Of the 287 patients included, 143 received metoprolol succinate 100 mg/day, and 144 received no BB and served as the control group. Baseline clinical characteristics of both groups, except for history of coronary artery bypass graft surgery, were similar. We observed no significant difference in the elevation of cTnI levels between the two groups after PCI (BB group, 17 patients, 11.9%; control group, 10 patients, 6.9%; P=0.2). CONCLUSION Metoprolol succinate therapy seems to have no cardioprotective effect in limiting troponin-I rise after PCI.
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Affiliation(s)
- Ilyas Atar
- Department of Cardiology, Faculty of Medicine, University of Başkent, Ankara, Turkey.
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Jaumdally R, Lip GYH, Varma C. Percutaneous coronary interventions for coronary artery disease: the long and short of optimizing medical therapy. Int J Clin Pract 2005; 59:1070-81. [PMID: 16115184 DOI: 10.1111/j.1742-1241.2005.00608.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Atherosclerosis is a dynamic process and timely introduction of pharmacological treatment can have a significant bearing on the patient's health and outcome. In addition to treating the culprit lesion mechanically, admission for percutaneous coronary interventions (PCI) for coronary artery disease (CAD) gives an opportunity for the interventional cardiologist to optimize medical therapy. The aim of this review is to provide an overview of the current medical literature pertaining to cardiovascular (CV) risk reduction and vascular event prevention in the setting of PCI, with emphasis on antiplatelet therapies, beta-blockers, HMG-Co A reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors, with regard to therapy optimization during PCI and for chronic CAD. We discuss the effects of these oral therapies in reducing ischaemic events, thus augmenting the benefits of PCI, as well as preventing recurrent CV events after the procedure.
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Affiliation(s)
- R Jaumdally
- University Department of Medicine, City Hospital, Birmingham, UK
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31
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López-Sendón J, Swedberg K, McMurray J, Tamargo J, Maggioni AP, Dargie H, Tendera M, Waagstein F, Kjekshus J, Lechat P, Torp-Pedersen C. Documento de Consenso de Expertos sobre bloqueadores de los receptores ß-adrenérgicos. Rev Esp Cardiol 2005; 58:65-90. [PMID: 15680133 DOI: 10.1157/13070510] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Labinaz M, Mathias J, Pieper K, Granger CB, Lincoff AM, Moliterno DJ, Van de Werf F, Simes J, White HD, Simoons ML, Califf RM, Topol EJ, Armstrong PW, Harrington RA. Outcomes of patients with acute coronary syndromes and prior percutaneous coronary intervention: a pooled analysis of three randomized clinical trials. Eur Heart J 2004; 26:128-36. [PMID: 15618068 DOI: 10.1093/eurheartj/ehi061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS We sought to characterize the outcomes of patients with a prior percutaneous coronary intervention (PCI) who presented with a non-ST-segment elevation acute coronary syndrome (ACS). METHODS AND RESULTS We analysed the 30 and 180 day outcomes of 3012 patients with prior PCI and 21 154 patients without prior PCI enrolled in three randomized ACS trials (GUSTO IIb, PURSUIT, and PARAGON-B). The median (25th, 75th percentile) interval between the prior PCI and randomization was 647 (123, 1585) days. Patients with prior PCI had significantly more adverse baseline clinical characteristics, left ventricular dysfunction, and multi-vessel coronary artery disease. After adjusting for baseline characteristics and treatment, we found that patients with prior PCI had a significantly lower mortality rate at 30 days [hazard ratio (HR), 0.60; 95% confidence interval (CI), 0.45-0.80; P=0.0006] and 180 days (HR, 0.81; 95% CI, 0.66-0.98; P=0.029). However, no difference was observed in the composite of death or myocardial infarction (MI) at 30 days (HR, 0.95; 95% CI, 0.83-1.08; P=0.42) or 180 days (HR, 1.01; 95% CI, 0.90-1.13; P=0.90). Patients with prior PCI had a higher rate of MI at 180 days (13.3 vs. 12.0%; P=0.045). Prior-PCI patients had lower incidences of in-hospital cardiogenic shock, congestive heart failure (CHF), and atrial fibrillation. CONCLUSION Patients with prior PCI who present with non-ST-segment elevation ACS have a lower mortality rate than those without prior PCI.
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Affiliation(s)
- Marino Labinaz
- University of Ottawa Heart Institute, Division of Cardiology, 40 Ruskin Ave, Rm H-150 Ottawa, Ontario, K1Y 4W7 Canada.
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Faxon DP. Can beta-blocker use lower mortality and improve myocardial tissue recovery after acute myocardial infarction? NATURE CLINICAL PRACTICE. CARDIOVASCULAR MEDICINE 2004; 1:14-5. [PMID: 16265251 DOI: 10.1038/ncpcardio0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Accepted: 09/20/2004] [Indexed: 05/05/2023]
Affiliation(s)
- David P Faxon
- Section of Cardiology at the University of Chicago, IL, USA.
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Halkin A, Grines CL, Cox DA, Garcia E, Mehran R, Tcheng JE, Griffin JJ, Guagliumi G, Brodie B, Turco M, Rutherford BD, Aymong E, Lansky AJ, Stone GW. Impact of intravenous Beta-Blockade before primary angioplasty on survival in patients undergoing mechanical reperfusion therapy for acute myocardial infarction. J Am Coll Cardiol 2004; 43:1780-7. [PMID: 15145099 DOI: 10.1016/j.jacc.2003.10.068] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2003] [Revised: 10/13/2003] [Accepted: 10/20/2003] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to examine the effect of intravenous beta-blockers administered before primary percutaneous coronary intervention (PCI) on survival and myocardial recovery after acute myocardial infarction (AMI). BACKGROUND Studies of primary PCI but not thrombolysis have suggested that beta-blocker administration before reperfusion may enhance survival. Whether oral beta-blocker use before admission modulates this effect is unknown. METHODS The Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial randomized 2082 AMI patients to either stenting or balloon angioplasty, each +/- abciximab. In accordance with the protocol, intravenous beta-blockers were administered before PCI in the absence of contraindications. RESULTS A total of 1136 patients (54.5%, BB+ group) received beta-blockers before PCI, whereas 946 (45.5%, BB- group) did not. The 30-day mortality was significantly lower in the BB+ group than in the BB- group (1.5% vs. 2.8%, p = 0.03), an effect entirely limited to patients who had not been receiving beta-blockers before admission (1.2% vs. 2.9%, p = 0.007). In contrast, no survival benefit with pre-procedural beta-blockers was observed in patients receiving beta-blockers at home (3.3% vs. 1.9%, respectively, p = 0.47). By multivariate analysis, pre-procedural beta-blocker use was an independent predictor of lower 30-day mortality among patients without previous beta-blocker therapy (relative risk = 0.38 [95% confidence interval 0.17 to 0.87], p = 0.02). The improvement in left ventricular ejection fraction from baseline to seven months was also greater after intravenous beta-blockers (3.8% vs. 1.3%, p = 0.01), an effect limited to patients not receiving oral beta-blockers before admission. CONCLUSIONS In patients with AMI undergoing primary PCI, myocardial recovery is enhanced and 30-day mortality is reduced with pre-procedural intravenous beta-blockade, effects confined to patients untreated with oral beta-blocker medication before admission.
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Affiliation(s)
- Amir Halkin
- Cardiovascular Research Foundation and Lenox Hill Heart and Vascular Institute, New York, New York, USA
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Kernis SJ, Harjai KJ, Stone GW, Grines LL, Boura JA, O'Neill WW, Grines CL. Does beta-blocker therapy improve clinical outcomes of acute myocardial infarction after successful primary angioplasty? J Am Coll Cardiol 2004; 43:1773-9. [PMID: 15145098 DOI: 10.1016/j.jacc.2003.09.071] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2003] [Revised: 09/19/2003] [Accepted: 09/23/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We sought to determine if beta-blocker therapy improves clinical outcomes of acute myocardial infarction (AMI) after successful primary percutaneous coronary intervention (PCI). BACKGROUND We have shown that pre-treatment with beta-blockers has a beneficial effect on short-term clinical outcomes in patients undergoing primary PCI for AMI. It is unknown if beta-blocker therapy after successful primary PCI improves prognosis of AMI. METHODS We analyzed clinical, angiographic, and outcomes data in 2442 patients who underwent successful primary PCI in the Primary Angioplasty in Acute Myocardial Infarction-2 (PAMI-2), PAMI No Surgery-on-Site (PAMI noSOS), Stent PAMI, and Air PAMI trials. We classified patients into beta group (those who received beta-blockers after successful PCI, n = 1661) and no-beta group (n = 781). We compared death and major adverse cardiac events (MACE) (death, reinfarction, and ischemia-driven target vessel revascularization) at six months between groups receiving and not receiving beta-blockers. RESULTS At six months, beta patients were less likely to die (2.2% vs. 6.6%, p < 0.0001) or experience MACE (14 vs. 17%, p = 0.036). In multivariate analysis, beta-blockers were independently associated with lower six-month mortality (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.26 to 0.73, p = 0.0016). Beta-blocker therapy was an independent predictor of lower six-month events in high-risk subgroups: ejection fraction <or=50% (death: OR 0.34, 95% CI 0.19 to 0.60, p = 0.0002) or multi-vessel coronary artery disease (CAD) (death: OR 0.26, 95% CI 0.14 to 0.48, p < 0.0001; MACE: OR 0.57, 95% CI 0.41 to 0.80, p = 0.0011). CONCLUSIONS Treatment with beta-blockers after successful primary PCI is associated with reduced six-month mortality, with the greatest benefit in patients with a low ejection fraction or multi-vessel CAD.
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Affiliation(s)
- Steven J Kernis
- Cardiology Division, William Beaumont Hospital, Royal Oak, Michigan 48331, USA.
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