Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study

Besides its protective effect against neutrophil-mediated injury at reperfusion, intravenous (IV) metoprolol was recently shown to reduce the progression of ischemic injury in a pig model of ST-segment elevation myocardial infarction (STEMI). Here, we tested the hypothesis that IV metoprolol adminis...

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Authors: Díaz Muñoz, Raquel, Valle Caballero, María José, Sánchez González, Javier, Pizarro, Gonzalo, García Rubira, Juan Carlos, Escalera, Noemí, Fuster, Valentín, Fernández Jiménez, Rodrigo, Ibáñez Cabeza, Borja
Format: article
Publication Date:2021
Country:España
Institution:Universidad Europea (UEM)
Repository:ABACUS. Repositorio de Producción Científica
Language:English
OAI Identifier:oai:abacus.universidadeuropea.com:11268/11403
Online Access:http://hdl.handle.net/11268/11403
Access Level:Open access
Keyword:Electrocardiografía
Imagen por resonancia magnética
Antagonistas adrenérgicos
Enfermedad cardiovascular
Medicina preventiva
Tecnología médica
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spelling Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic studyDíaz Muñoz, RaquelValle Caballero, María JoséSánchez González, JavierPizarro, GonzaloGarcía Rubira, Juan CarlosEscalera, NoemíFuster, ValentínFernández Jiménez, RodrigoIbáñez Cabeza, BorjaElectrocardiografíaImagen por resonancia magnéticaAntagonistas adrenérgicosEnfermedad cardiovascularMedicina preventivaTecnología médicaBesides its protective effect against neutrophil-mediated injury at reperfusion, intravenous (IV) metoprolol was recently shown to reduce the progression of ischemic injury in a pig model of ST-segment elevation myocardial infarction (STEMI). Here, we tested the hypothesis that IV metoprolol administration in humans with ongoing STEMI blunts the time‑dependent progression of ischemic injury assessed by serial electrocardiogram (ECG) evaluations before reperfusion. The METOCARD-CNIC trial randomized 270 anterior STEMI patients to IV metoprolol or control before reperfusion by percutaneous coronary intervention (PCI). In 139 patients (69 IV metoprolol, 70 controls), two ECGs were available (ECG-1 before randomization, ECG-2 pre-PCI). Between-group ECG differences were analyzed using univariate and multivariate regression models. No significant between-group differences were observed on ECG-1. On ECG-2, patients who received IV metoprolol had a narrower QRS than those in the control group (84 ms vs. 90 ms, p = 0.029), a lower prevalence of QRS distortion (10% vs. 26%, p = 0.017), and a lower sum of anterior and total ST-segment elevation (10.1 mm vs. 13.6 mm, p = 0.014 and 10.4 mm vs. 14.0 mm, p = 0.015, respectively). Adjusted analysis revealed similar results. Significant associations were observed between ECG-2 variables and cardiac magnetic resonance imaging measurements (extent of myocardial edema, infarct size, microvascular obstruction, and left-ventricular ejection fraction) after STEMI. In summary, IV metoprolol administration before reperfusion ameliorates ECG markers of myocardial ischemia in anterior STEMI patients. These data confirm that IV metoprolol is able to reduce ischemic injury and highlight the ability of ECG analysis to provide relevant real-time information on the effect of cardioprotective therapies before reperfusion.20222022-06-2920212021-01-0120212021-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articlehttp://hdl.handle.net/11268/11403reponame:ABACUS. Repositorio de Producción Científicainstname:Universidad Europea (UEM)InglésengEuropean Commission http://dx.doi.org/10.13039/501100000780 Horizon 2020 Framework Programme ERC-CoG 819775-MATRIXEuropean Commission http://dx.doi.org/10.13039/501100000780 Horizon 2020 Framework Programme 707642open accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:abacus.universidadeuropea.com:11268/114032026-06-11T12:41:27Z
dc.title.none.fl_str_mv Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study
title Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study
spellingShingle Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study
Díaz Muñoz, Raquel
Electrocardiografía
Imagen por resonancia magnética
Antagonistas adrenérgicos
Enfermedad cardiovascular
Medicina preventiva
Tecnología médica
title_short Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study
title_full Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study
title_fullStr Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study
title_full_unstemmed Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study
title_sort Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study
dc.creator.none.fl_str_mv Díaz Muñoz, Raquel
Valle Caballero, María José
Sánchez González, Javier
Pizarro, Gonzalo
García Rubira, Juan Carlos
Escalera, Noemí
Fuster, Valentín
Fernández Jiménez, Rodrigo
Ibáñez Cabeza, Borja
author Díaz Muñoz, Raquel
author_facet Díaz Muñoz, Raquel
Valle Caballero, María José
Sánchez González, Javier
Pizarro, Gonzalo
García Rubira, Juan Carlos
Escalera, Noemí
Fuster, Valentín
Fernández Jiménez, Rodrigo
Ibáñez Cabeza, Borja
author_role author
author2 Valle Caballero, María José
Sánchez González, Javier
Pizarro, Gonzalo
García Rubira, Juan Carlos
Escalera, Noemí
Fuster, Valentín
Fernández Jiménez, Rodrigo
Ibáñez Cabeza, Borja
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv Electrocardiografía
Imagen por resonancia magnética
Antagonistas adrenérgicos
Enfermedad cardiovascular
Medicina preventiva
Tecnología médica
topic Electrocardiografía
Imagen por resonancia magnética
Antagonistas adrenérgicos
Enfermedad cardiovascular
Medicina preventiva
Tecnología médica
description Besides its protective effect against neutrophil-mediated injury at reperfusion, intravenous (IV) metoprolol was recently shown to reduce the progression of ischemic injury in a pig model of ST-segment elevation myocardial infarction (STEMI). Here, we tested the hypothesis that IV metoprolol administration in humans with ongoing STEMI blunts the time‑dependent progression of ischemic injury assessed by serial electrocardiogram (ECG) evaluations before reperfusion. The METOCARD-CNIC trial randomized 270 anterior STEMI patients to IV metoprolol or control before reperfusion by percutaneous coronary intervention (PCI). In 139 patients (69 IV metoprolol, 70 controls), two ECGs were available (ECG-1 before randomization, ECG-2 pre-PCI). Between-group ECG differences were analyzed using univariate and multivariate regression models. No significant between-group differences were observed on ECG-1. On ECG-2, patients who received IV metoprolol had a narrower QRS than those in the control group (84 ms vs. 90 ms, p = 0.029), a lower prevalence of QRS distortion (10% vs. 26%, p = 0.017), and a lower sum of anterior and total ST-segment elevation (10.1 mm vs. 13.6 mm, p = 0.014 and 10.4 mm vs. 14.0 mm, p = 0.015, respectively). Adjusted analysis revealed similar results. Significant associations were observed between ECG-2 variables and cardiac magnetic resonance imaging measurements (extent of myocardial edema, infarct size, microvascular obstruction, and left-ventricular ejection fraction) after STEMI. In summary, IV metoprolol administration before reperfusion ameliorates ECG markers of myocardial ischemia in anterior STEMI patients. These data confirm that IV metoprolol is able to reduce ischemic injury and highlight the ability of ECG analysis to provide relevant real-time information on the effect of cardioprotective therapies before reperfusion.
publishDate 2021
dc.date.none.fl_str_mv 2021
2021-01-01
2021
2021-01-01
2022
2022-06-29
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/11268/11403
url http://hdl.handle.net/11268/11403
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv European Commission http://dx.doi.org/10.13039/501100000780 Horizon 2020 Framework Programme ERC-CoG 819775-MATRIX
European Commission http://dx.doi.org/10.13039/501100000780 Horizon 2020 Framework Programme 707642
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.source.none.fl_str_mv reponame:ABACUS. Repositorio de Producción Científica
instname:Universidad Europea (UEM)
instname_str Universidad Europea (UEM)
reponame_str ABACUS. Repositorio de Producción Científica
collection ABACUS. Repositorio de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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