Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention

Vincent Roolvink, Borja Ibanez, Jan Paul Ottervanger, Gonzalo Pizarro, Niels van Royen, Alonso Mateos, Jan-Henk E. Dambrink, Noemi Escalera, Erik Lipsic, Agustin Albarran, Antonio Fernandez-Ortiz, Francisco Fernandez-Aviles, Javier Goicolea, Javier Botas, Wouter Remkes, Victoria Hernandez-Jaras, Elvin Kedhi, Jose L. Zamorano, Felipe Navarro, Fernando AlfonsoAlberto Garcia-Lledo, Joaquin Alonso, Maarten van Leeuwen, Robin Nijveldt, Sonja Postma, Evelien Kolkman, Marcel Gosselink, Bart de Smet, Saman Rasoul, Jan J. Piek, Valentin Fuster, Arnoud W. J. Van 't Hof

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Abstract

Background The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. Objectives This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing the effect of early IV beta-blockers before PPCI in a general ST-segment elevation myocardial infarction (STEMI) population. Methods STEMI patients presenting <12 h from symptom onset in Killip class I to II without atrioventricular block were randomized 1:1 to IV metoprolol (2 × 5-mg bolus) or matched placebo before PPCI. Primary endpoint was myocardial infarct size as assessed by cardiac magnetic resonance imaging (CMR) at 30 days. Secondary endpoints were enzymatic infarct size and incidence of ventricular arrhythmias. Safety endpoints included symptomatic bradycardia, symptomatic hypotension, and cardiogenic shock. Results A total of 683 patients (mean age 62 ± 12 years; 75% male) were randomized to metoprolol (n = 336) or placebo (n = 346). CMR was performed in 342 patients (54.8%). Infarct size (percent of left ventricle [LV]) by CMR did not differ between the metoprolol (15.3 ± 11.0%) and placebo groups (14.9 ± 11.5%; p = 0.616). Peak and area under the creatine kinase curve did not differ between both groups. LV ejection fraction by CMR was 51.0 ± 10.9% in the metoprolol group and 51.6 ± 10.8% in the placebo group (p = 0.68). The incidence of malignant arrhythmias was 3.6% in the metoprolol group versus 6.9% in placebo (p = 0.050). The incidence of adverse events was not different between groups. Conclusions In a nonrestricted STEMI population, early intravenous metoprolol before PPCI was not associated with a reduction in infarct size. Metoprolol reduced the incidence of malignant arrhythmias in the acute phase and was not associated with an increase in adverse events. (Early-Beta blocker Administration before reperfusion primary PCI in patients with ST-elevation Myocardial Infarction [EARLY-BAMI]; EudraCT no: 2010-023394-19)
Original languageEnglish
Pages (from-to)2705-2715
JournalJournal of the American College of Cardiology
Volume67
Issue number23
DOIs
Publication statusPublished - 14 Jun 2016

Keywords

  • cardiac magnetic resonance
  • ejection fraction
  • infarct size
  • metoprolol

Cite this

Roolvink, V., Ibanez, B., Ottervanger, J. P., Pizarro, G., van Royen, N., Mateos, A., Dambrink, J-H. E., Escalera, N., Lipsic, E., Albarran, A., Fernandez-Ortiz, A., Fernandez-Aviles, F., Goicolea, J., Botas, J., Remkes, W., Hernandez-Jaras, V., Kedhi, E., Zamorano, J. L., Navarro, F., ... Van 't Hof, A. W. J. (2016). Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention. Journal of the American College of Cardiology, 67(23), 2705-2715. https://doi.org/10.1016/j.jacc.2016.03.522