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.
  
  
  OBJECTIVE
  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).
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: Roolvink
authors.affiliation: Department of Cardiology, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Department of Cardiology, IIS-Fundacion Jimenez Díaz Hospital, Madrid, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Ibáñez
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Cardiology, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Department of Cardiology, Hospital Universitario Quirón, Universidad Europea de Madrid & Hospital Ruber-Quirónsalud, Madrid, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Pizarro
authors.affiliation: Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Niels
authors.initials: N
authors.lastname: van Royen
authors.affiliation: Department of Cardiology, Servicio de Urgencia Medica de Madrid (SUMMA 112), Madrid, Spain.
authors.forename: Alonso
authors.initials: A
authors.lastname: Mateos
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.
authors.forename: Jan-Henk E
authors.initials: JE
authors.lastname: Dambrink
authors.affiliation: Department of Cardiology, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Noemi
authors.initials: N
authors.lastname: Escalera
authors.affiliation: Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Lipsic
authors.affiliation: Department of Cardiology, Codigo Infarto, Madrid, Spain; Department of Cardiology, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Albarran
authors.affiliation: Department of Cardiology, Codigo Infarto, Madrid, Spain; Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Ortiz
authors.affiliation: Department of Cardiology, Codigo Infarto, Madrid, Spain; Department of Cardiology, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Department of Cardiology, Codigo Infarto, Madrid, Spain; Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Goicolea
authors.affiliation: Department of Cardiology, Codigo Infarto, Madrid, Spain; Department of Cardiology, Hospital Fundación Alcorcón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Botas
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Remkes
authors.affiliation: Department of Cardiology, Servicio de Urgencia Medica de Madrid (SUMMA 112), Madrid, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hernandez-Jaras
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.
authors.forename: Elvin
authors.initials: E
authors.lastname: Kedhi
authors.affiliation: Department of Cardiology, Codigo Infarto, Madrid, Spain; Department of Cardiology, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Zamorano
authors.affiliation: Department of Cardiology, IIS-Fundacion Jimenez Díaz Hospital, Madrid, Spain; Department of Cardiology, Codigo Infarto, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Navarro
authors.affiliation: Department of Cardiology, Codigo Infarto, Madrid, Spain; Department of Cardiology, Hospital de La Princesa, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.affiliation: Department of Cardiology, Codigo Infarto, Madrid, Spain; Department of Cardiology, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Lledó
authors.affiliation: Department of Cardiology, Codigo Infarto, Madrid, Spain; Department of Cardiology, Hospital de Getafe, Madrid, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Leeuwen
authors.affiliation: Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Robin
authors.initials: R
authors.lastname: Nijveldt
authors.affiliation: Diagram, Diagnostic Research and Management, Zwolle, the Netherlands.
authors.forename: Sonja
authors.initials: S
authors.lastname: Postma
authors.affiliation: Diagram, Diagnostic Research and Management, Zwolle, the Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Kolkman
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: Gosselink
authors.affiliation: Department of Cardiology, Meander Medisch Centrum, Amersfoort, the Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: de Smet
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Saman
authors.initials: S
authors.lastname: Rasoul
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.affiliation: Department of Cardiology, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands. Electronic address: v.r.c.derks@isala.nl.
authors.forename: Arnoud W J
authors.initials: AWJ
authors.lastname: van 't Hof
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D003402:Creatine Kinase / Q000032:analysis; D004311:Double-Blind Method; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D011292:Premedication; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume
chemical_list: D000319:Adrenergic beta-Antagonists; D003402:Creatine Kinase; D008790:Metoprolol
keywords: cardiac magnetic resonance; ejection fraction; infarct size; metoprolol