Abstract:
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).
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Pizarro G,Fernández-Friera L,Fuster V,Fernández-Jiménez R,García-Ruiz JM,García-Álvarez A,Mateos A,Barreiro MV,Escalera N,Rodriguez MD,de Miguel A,García-Lunar I,Parra-Fuertes JJ,Sánchez-González J,Pardillos L,Nieto B,Jimdoi
10.1016/j.jacc.2014.03.014subject
Has Abstractpub_date
2014-06-10 00:00:00pages
2356-62issue
22eissn
0735-1097issn
1558-3597pii
S0735-1097(14)01682-9journal_volume
63pub_type
杂志文章,随机对照试验abstract::The relation among right ventricular preload, afterload and ejection fraction in patients with mitral valve disease has not been well elucidated. In this study, measurements were made of intracardiac pressures and forward cardiac output during cardiac catheterization (n = 43), the ejection fraction by radionuclide ang...
journal_title:Journal of the American College of Cardiology
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abstract::Clinical and necropsy findings are described in 56 patients with mitral valve prolapse: 15 patients, aged 16 to 69 years (mean 39), died suddenly and mitral valve prolapse was the only cardiac condition found at necropsy (hereafter called isolated mitral valve prolapse); the remaining 41 patients had other conditions ...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/0735-1097(91)90875-a
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journal_title:Journal of the American College of Cardiology
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更新日期:2010-10-12 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:1998-11-01 00:00:00
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更新日期:2016-04-05 00:00:00
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更新日期:2014-03-25 00:00:00
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更新日期:2006-02-21 00:00:00
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doi:10.1016/j.jacc.2008.03.047
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更新日期:2016-04-19 00:00:00
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1995-05-01 00:00:00
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更新日期:1997-10-01 00:00:00
abstract:OBJECTIVES:This study aimed to investigate the effect of both history of intermittent atrial tachyarrhythmias (IAT) and in-trial IAT on the risk of heart failure (HF) or death comparing cardiac resynchronization therapy with defibrillator (CRT-D) to implantable cardioverter-defibrillator (ICD) treatment in mildly sympt...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2013.10.074
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Small-scale studies focused mainly on nonischemic cardiomyopathy (NICM) have shown that a subset of left ventricular assist device (LVAD) patients can achieve significant improvement of their native heart function, but the impact of ischemic cardiomyopathy (ICM) has not been specifically investigated. Many p...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2016.07.756
更新日期:2016-10-18 00:00:00
abstract:OBJECTIVES:We investigated whether the reverse remodeling after cardiac resynchronization therapy (CRT) might reduce the occurrence of ventricular arrhythmias (VAs). BACKGROUND:It is currently debated whether CRT has an effect on the burden of VAs. METHODS:The study included 398 patients treated with a CRT defibrilla...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2008.07.043
更新日期:2008-10-28 00:00:00