Early metoprolol treatment beneficial for STEMI patients, finds study
Delhi: Early metoprolol treatment improves long-term outcomes in STEMI patients, suggests a recent study in the American Journal of Cardiology.
Tomaz Podlesnikar, University Medical Centre Maribor, Maribor, Slovenia, and colleagues investigated the long-term impact of early intravenous metoprolol in ST-segment elevation myocardial infarction (STEMI) patients in terms of left ventricular (LV) strain with feature-tracking cardiovascular magnetic resonance (CMR) and its association with prognosis.
The study involved 270 patients having anterior STEMI. They were randomly assigned to receive 15 mg intravenous metoprolol (n=139) or conventional STEMI therapy (n=214). The researchers also performed feature-tracking cardiovascular magnetic resonance for 215 patients at 1-week post-STEMI to assess left ventricular global circumferential strain (GCS) and longitudinal strain (GLS). Patients were divided into groups based on GCS and GLS values and treatment group to explore the effects of metoprolol on left ventricular features.
Key findings of the study include:
- At the 5 year follow-up, 17.8% of patients presented with major cardiac events.
- Patients who received metoprolol vs standard therapy had fewer cumulative cardiac events (hazard ratio [HR], 0.500) and admissions for heart failure (HR, 0.298).
- Participants in the group with impaired left ventricular strain (ie, GCS ≥-13.1 or GLS ≥-11.5%) who received standard therapy had the greatest rate of MACE.
- Patients with impaired GLS who received metoprolol vs conventional STEMI therapy were 64% less likely to experience MACE (HR, 0.356).
"Early intravenous metoprolol has a long-term beneficial prognostic effect, particularly in patients who were at a greater risk for the occurrence of MACE due to severely impaired LV systolic function," wrote the authors. "Moreover, global LV strain assessment with feature-tracking CMR early after primary PCI provides important information in risk stratification of STEMI patients.,"
"LV GLS offers incremental prognostic value over traditional markers of LV injury, such as LVEF and infarct size with LGE," they concluded.
The study, "Five-Year Outcomes and Prognostic Value of Feature-Tracking Cardiovascular Magnetic Resonance in Patients Receiving Early Prereperfusion Metoprolol in Acute Myocardial Infarction," is published in the American Journal of Cardiology.
