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 Alfonso; Alberto 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; EARLY-BAMI Investigators

doi:10.1016/j.jacc.2016.03.522

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^*, EARLY-BAMI Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

157 Citations (Scopus)

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

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. (C) 2016 by the American College of Cardiology Foundation.

Original language	English
Pages (from-to)	2705-2715
Number of pages	11
Journal	Journal of the American College of Cardiology
Volume	67
Issue number	23
DOIs	https://doi.org/10.1016/j.jacc.2016.03.522
Publication status	Published - 14-Jun-2016

Keywords

cardiac magnetic resonance
ejection fraction
infarct size
metoprolol
CLINICAL-TRIAL
METOPROLOL
SIZE
PROPRANOLOL
DESIGN
CARDIOPROTECTION
CARVEDILOL
RATIONALE
EFFICACY
FAILURE

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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., ... EARLY-BAMI Investigators (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

@article{8f043f2c5bd843a1b21d1302c5127c18,

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

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 presentingRESULTS 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. (C) 2016 by the American College of Cardiology Foundation.",

keywords = "cardiac magnetic resonance, ejection fraction, infarct size, metoprolol, CLINICAL-TRIAL, METOPROLOL, SIZE, PROPRANOLOL, DESIGN, CARDIOPROTECTION, CARVEDILOL, RATIONALE, EFFICACY, FAILURE",

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

year = "2016",

month = jun,

day = "14",

doi = "10.1016/j.jacc.2016.03.522",

language = "English",

volume = "67",

pages = "2705--2715",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "ELSEVIER SCIENCE INC",

number = "23",

}

Roolvink, V, Ibanez, B, Ottervanger, JP, Pizarro, G, van Royen, N, Mateos, A, Dambrink, J-HE, Escalera, N, Lipsic, E, Albarran, A, Fernandez-Ortiz, A, Fernandez-Aviles, F, Goicolea, J, Botas, J, Remkes, W, Hernandez-Jaras, V, Kedhi, E, Zamorano, JL, Navarro, F, Alfonso, F, Garcia-Lledo, A, Alonso, J, van Leeuwen, M, Nijveldt, R, Postma, S, Kolkman, E, Gosselink, M, de Smet, B, Rasoul, S, Piek, JJ, Fuster, V, Van 't Hof, AWJ & EARLY-BAMI Investigators 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, vol. 67, no. 23, pp. 2705-2715. https://doi.org/10.1016/j.jacc.2016.03.522

Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention. / Roolvink, Vincent; Ibanez, Borja; Ottervanger, Jan Paul et al.
In: Journal of the American College of Cardiology, Vol. 67, No. 23, 14.06.2016, p. 2705-2715.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention

AU - Roolvink, Vincent

AU - Ibanez, Borja

AU - Ottervanger, Jan Paul

AU - Pizarro, Gonzalo

AU - van Royen, Niels

AU - Mateos, Alonso

AU - Dambrink, Jan-Henk E.

AU - Escalera, Noemi

AU - Lipsic, Erik

AU - Albarran, Agustin

AU - Fernandez-Ortiz, Antonio

AU - Fernandez-Aviles, Francisco

AU - Goicolea, Javier

AU - Botas, Javier

AU - Remkes, Wouter

AU - Hernandez-Jaras, Victoria

AU - Kedhi, Elvin

AU - Zamorano, Jose L.

AU - Navarro, Felipe

AU - Alfonso, Fernando

AU - Garcia-Lledo, Alberto

AU - Alonso, Joaquin

AU - van Leeuwen, Maarten

AU - Nijveldt, Robin

AU - Postma, Sonja

AU - Kolkman, Evelien

AU - Gosselink, Marcel

AU - de Smet, Bart

AU - Rasoul, Saman

AU - Piek, Jan J.

AU - Fuster, Valentin

AU - Van 't Hof, Arnoud W. J.

AU - EARLY-BAMI Investigators

PY - 2016/6/14

Y1 - 2016/6/14

N2 - 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 presentingRESULTS 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. (C) 2016 by the American College of Cardiology Foundation.

AB - 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 presentingRESULTS 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. (C) 2016 by the American College of Cardiology Foundation.

KW - cardiac magnetic resonance

KW - ejection fraction

KW - infarct size

KW - metoprolol

KW - CLINICAL-TRIAL

KW - METOPROLOL

KW - SIZE

KW - PROPRANOLOL

KW - DESIGN

KW - CARDIOPROTECTION

KW - CARVEDILOL

KW - RATIONALE

KW - EFFICACY

KW - FAILURE

U2 - 10.1016/j.jacc.2016.03.522

DO - 10.1016/j.jacc.2016.03.522

M3 - Article

SN - 0735-1097

VL - 67

SP - 2705

EP - 2715

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 23

ER -

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

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