Beta-blocker effect on ST-segment: a prespecified analysis of the EARLY-BAMI randomised trial.

Abstract

OBJECTIVE:

The effect of early intravenous (IV) beta-blockers (BBs) administration in patients undergoing primary percutaneous coronary intervention (pPCI) on ST-segment deviation is unknown. We undertook a prespecified secondary analysis of the Early Beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction (EARLY-BAMI) trial to investigate the effect of early IV BB on ST-segment deviation.

METHODS:

The EARLY-BAMI trial randomised patients with ST-elevation myocardial infarction (STEMI) to IV metoprolol (2×5 mg bolus) or matched placebo before pPCI. The prespecified outcome, evaluated by an independent core laboratory blinded to study treatment, was the residual ST-segment deviation 1 hour after pPCI (ie, the percentage of patients with >3 mm cumulative ST deviation at 1 hour after pPCI).

RESULTS:

An ECG for the evaluation of residual ST-segment deviation 1 hour after pPCI was available in 442 out of 683 randomised patients. The BB group had a lower heart rate after pPCI compared with placebo (71.2±13.2 vs 74.3±13.6, p=0.016); however, no differences were noted in the percentages of patients with >3 mm cumulative ST deviation at 1 hour after pPCI (58.6% vs 54.1%, p=0.38, in BB vs placebo, respectively) neither a significant difference was found for the percentages of patients in each of the four prespecified groups (normalised ST-segment; 1-3 mm; 4-6 mm;>6 mm residual ST-deviation).

CONCLUSIONS:

In patients with STEMI, who were being transported for primary PCI, early IV BB administration did not significantly affect ST-segment deviation after pPCI compared with placebo. The neutral result of early IV BB administration on an early marker of pharmacological effect is consistent with the absence of subsequent improvement of clinical outcomes.

• Authors: Enrico Fabris, Renicus Hermanides, Vincent Roolvink, Borja Ibanez, Jan Paul Ottervanger, Gonzalo Pizarro, Niels van Royen, Alonso Mateos-Rodriguez, Jan Henk Dambrink, Agustin Albarran, Francisco Fernández-Avilés, Javier Botas, Wouter Remkes, Victoria Hernandez-Jaras, Elvin Kedhi, Jose Zamorano, Fernando Alfonso, Alberto García-Lledó, Maarten van Leeuwen, Robin Nijveldt, Sonja Postma, Evelien Kolkman, Marcel Gosselink, Bart de Smet, Saman Rasoul, Erik Lipsic, Jan J Piek, Valentin Fuster, Arnoud Wj van 't Hof
• Journal: Open heart (Open Heart) Vol. 7 Issue 2 (12 2020) ISSN: 2053-3624 [Print] England
• PMID: 33318150 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Adrenergic beta-1 Receptor Antagonists
• Metoprolol

Topics

• Adrenergic beta-1 Receptor Antagonists (administration & dosage)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Electrocardiography (drug effects)
• Female
• Humans
• Male
• Metoprolol (administration & dosage)
• Middle Aged
• Percutaneous Coronary Intervention (methods)
• ST Elevation Myocardial Infarction (diagnosis, therapy)
• Treatment Outcome