TY - JOUR
T1 - Beta-blocker effect on ST-segment
T2 - a prespecified analysis of the EARLY-BAMI randomised trial
AU - Fabris, Enrico
AU - Hermanides, Renicus
AU - Roolvink, Vincent
AU - Ibanez, Borja
AU - Ottervanger, Jan Paul
AU - Pizarro, Gonzalo
AU - van Royen, Niels
AU - Mateos-Rodriguez, Alonso
AU - Dambrink, Jan Henk
AU - Albarran, Agustin
AU - Fernandez-Aviles, Francisco
AU - Botas, Javier
AU - Remkes, Wouter
AU - Hernandez-Jaras, Victoria
AU - Kedhi, Elvin
AU - Zamorano, Jose
AU - Alfonso, Fernando
AU - Garcia-Lledo, Alberto
AU - van Leeuwen, Maarten
AU - Nijveldt, Robin
AU - Postma, Sonja
AU - Kolkman, Evelien
AU - Gosselink, Marcel
AU - de Smet, Bart
AU - Rasoul, Saman
AU - Lipsic, Erik
AU - Piek, Jan J.
AU - Fuster, Valentin
AU - van 't Hof, Arnoud W. J.
N1 - Funding Information:
Funding Trial funding came from a research grant of the Dutch Heart Foundation (Utrecht, the Netherlands, no. 2010B125) and an unrestricted grant by Medtronic Inc. (Heerlen, the Netherlands), which was used for additional analyses.
Publisher Copyright:
©
PY - 2020
Y1 - 2020
N2 - Objective The effect of early intravenous (IV) beta-blockers (BBs) administration in patients undergoing primary percutaneous coronary intervention (pPCI) on ST-segment deviation is unknown. We undertook a prespecified secondary analysis of the Early Beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction (EARLY-BAMI) trial to investigate the effect of early IV BB on ST-segment deviation.Methods The EARLY-BAMI trial randomised patients with ST-elevation myocardial infarction (STEMI) to IV metoprolol (2x5 mg bolus) or matched placebo before pPCI. The prespecified outcome, evaluated by an independent core laboratory blinded to study treatment, was the residual ST-segment deviation 1 hour after pPCI (ie, the percentage of patients with >3 mm cumulative ST deviation at 1 hour after pPCI).Results An ECG for the evaluation of residual ST-segment deviation 1 hour after pPCI was available in 442 out of 683 randomised patients. The BB group had a lower heart rate after pPCI compared with placebo (71.2 +/- 13.2 vs 74.3 +/- 13.6, p=0.016); however, no differences were noted in the percentages of patients with >3 mm cumulative ST deviation at 1 hour after pPCI (58.6% vs 54.1%, p=0.38, in BB vs placebo, respectively) neither a significant difference was found for the percentages of patients in each of the four prespecified groups (normalised ST-segment; 1-3 mm; 4-6 mm;>6 mm residual ST-deviation).Conclusions In patients with STEMI, who were being transported for primary PCI, early IV BB administration did not significantly affect ST-segment deviation after pPCI compared with placebo. The neutral result of early IV BB administration on an early marker of pharmacological effect is consistent with the absence of subsequent improvement of clinical outcomes.
AB - Objective The effect of early intravenous (IV) beta-blockers (BBs) administration in patients undergoing primary percutaneous coronary intervention (pPCI) on ST-segment deviation is unknown. We undertook a prespecified secondary analysis of the Early Beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction (EARLY-BAMI) trial to investigate the effect of early IV BB on ST-segment deviation.Methods The EARLY-BAMI trial randomised patients with ST-elevation myocardial infarction (STEMI) to IV metoprolol (2x5 mg bolus) or matched placebo before pPCI. The prespecified outcome, evaluated by an independent core laboratory blinded to study treatment, was the residual ST-segment deviation 1 hour after pPCI (ie, the percentage of patients with >3 mm cumulative ST deviation at 1 hour after pPCI).Results An ECG for the evaluation of residual ST-segment deviation 1 hour after pPCI was available in 442 out of 683 randomised patients. The BB group had a lower heart rate after pPCI compared with placebo (71.2 +/- 13.2 vs 74.3 +/- 13.6, p=0.016); however, no differences were noted in the percentages of patients with >3 mm cumulative ST deviation at 1 hour after pPCI (58.6% vs 54.1%, p=0.38, in BB vs placebo, respectively) neither a significant difference was found for the percentages of patients in each of the four prespecified groups (normalised ST-segment; 1-3 mm; 4-6 mm;>6 mm residual ST-deviation).Conclusions In patients with STEMI, who were being transported for primary PCI, early IV BB administration did not significantly affect ST-segment deviation after pPCI compared with placebo. The neutral result of early IV BB administration on an early marker of pharmacological effect is consistent with the absence of subsequent improvement of clinical outcomes.
KW - STEMI
KW - beta blockers
KW - coronary intervention (PCI)
KW - ST-T changes
KW - reperfusion
KW - ELEVATION MYOCARDIAL-INFARCTION
KW - PERCUTANEOUS CORONARY INTERVENTION
KW - SIZE
KW - REPERFUSION
KW - METOPROLOL
U2 - 10.1136/openhrt-2020-001316
DO - 10.1136/openhrt-2020-001316
M3 - Article
C2 - 33318150
SN - 2053-3624
VL - 7
JO - Open Heart
JF - Open Heart
IS - 2
M1 - 001316
ER -