title: Randomized Control of Sympathetic Drive With Continuous Intravenous Esmolol in Patients With Acute ST-Segment Elevation Myocardial Infarction: The BEtA-Blocker Therapy in Acute Myocardial Infarction (BEAT-AMI) Trial.
abstract: OBJECTIVE
  This study sought to evaluate the role of esmolol-induced tight sympathetic control in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Elevated sympathetic drive has a detrimental effect on patients with acute STEMI. The effect of beta-blocker-induced heart rate mediated sympathetic control on myocardial damage is unknown.
  
  
  METHODS
  The authors conducted a prospective, randomized, single-blind trial involving patients with STEMI and successful percutaneous intervention (Killip class I and II). Patients were randomly allocated to heart rate control with intravenous esmolol for 24 h or placebo. The primary outcome was the maximum change in troponin T release as a prognostic surrogate marker for myocardial damage. A total of 101 patients were enrolled in the study.
  
  
  RESULTS
  There was a significant difference between patients allocated to placebo and those who received sympathetic control with esmolol in terms of maximum change in troponin T release: the median serum troponin T concentration increased from 0.2 ng/ml (interquartile range [IQR] 0.1 to 0.7 ng/ml) to 1.3 ng/ml (IQR: 0.6 to 4.7 ng/ml) in the esmolol group and from 0.3 ng/ml (IQR: 0.1 to 1.2 ng/ml) to 3.2 ng/ml (IQR: 1.5 to 5.3 ng/ml) in the placebo group (p = 0.010). The levels of peak creatine kinase (CK), CK subunit MB (CK-MB), and n-terminal brain natriuretic peptide (NT-proBNP) were lower in the esmolol group compared with placebo (CK 619 U/l [IQR: 250-1,701 U/l] vs. 1,308 U/l [IQR: 610 to 2,324 U/l]; p = 0.013; CKMB: 73.5 U/l [IQR: 30 to 192 U/l] vs. 158.5 U/l [IQR: 74 to 281 U/l]; p = 0.005; NT-proBNP: 1,048 pg/ml (IQR: 623 to 2,062 pg/ml] vs. 1,497 pg/ml [IQR: 739 to 3,318 pg/ml]; p = 0.059). Cardiogenic shock occurred in three patients in the placebo group and in none in the esmolol group.
  
  
  CONCLUSIONS
  Esmolol treatment statistically significantly decreased troponin T, CK, CK-MB and NT-proBNP release as surrogate markers for myocardial injury in patients with STEMI. (Heart Rate Control After Acute Myocardial Infarction; DRKS00000766).
authors: Klinikum Gütersloh, Department of Cardiology and Electrophysiology I, University Hospital Münster, Gütersloh, Germany. Electronic address: fikret.er@klinikum-guetersloh.de.
authors: Fikret
authors: F
authors: Er
authors: Department of Internal Medicine III, University of Cologne, Cologne, Germany.
authors: Kristina M
authors: KM
authors: Dahlem
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
authors: Amir M
authors: AM
authors: Nia
authors: Department of Internal Medicine III, University of Cologne, Cologne, Germany.
authors: Erland
authors: E
authors: Erdmann
authors: Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors: Johannes
authors: J
authors: Waltenberger
authors: Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
authors: Martin
authors: M
authors: Hellmich
authors: Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
authors: Kathrin
authors: K
authors: Kuhr
authors: Department of Internal Medicine III, University of Cologne, Cologne, Germany.
authors: Minh Tam
authors: MT
authors: Le
authors: Department of Internal Medicine III, University of Cologne, Cologne, Germany.
authors: Tina
authors: T
authors: Herrfurth
authors: Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany.
authors: Zulfugar
authors: Z
authors: Taghiyev
authors: Department of Cardiology and Electrophysiology, University of Witten/Herdecke, Medical Center Porz am Rhein, Cologne, Germany.
authors: Esther
authors: E
authors: Biesenbach
authors: Klinikum Gütersloh, Department of Cardiology and Electrophysiology I, University Hospital Münster, Gütersloh, Germany.
authors: Dilek
authors: D
authors: Yüksel
authors: Klinikum Gütersloh, Department of Cardiology and Electrophysiology I, University Hospital Münster, Gütersloh, Germany.
authors: Aslihan
authors: A
authors: Eran-Ergöknil
authors: Department of Internal Medicine III, University of Cologne, Cologne, Germany.
authors: Maria
authors: M
authors: Vanezi
authors: Department of Internal Medicine III, University of Cologne, Cologne, Germany.
authors: Evren
authors: E
authors: Caglayan
authors: Klinikum Gütersloh, Department of Cardiology and Electrophysiology I, University Hospital Münster, Gütersloh, Germany.
authors: Natig
authors: N
authors: Gassanov
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011412:Propanolamines / Q000627:therapeutic use*; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000453:epidemiology; D016037:Single-Blind Method; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D020107:Troponin T / Q000097:blood
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D015415:Biomarkers; D010446:Peptide Fragments; D011412:Propanolamines; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D003402:Creatine Kinase; C036604:esmolol
keywords: STEMI; beta-blocker; clinical trial; heart rate; sympathetic nervous system