Study Objective: We seek to examine the efficacy and safety of prereperfusion emergency medical services (EMS)-administered intravenous metoprolol in anterior ST-segment elevation myocardial infarction patients undergoing eventual primary angioplasty.
Methods: This is a prespecified subgroup analysis of the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction trial population, who all eventually received oral metoprolol within 12 to 24 hours. We studied patients receiving intravenous metoprolol by EMS and compared them with others treated by EMS but not receiving intravenous metoprolol. Outcomes included infarct size and left ventricular ejection fraction on cardiac magnetic resonance imaging at 1 week, and safety by measuring the incidence of the predefined combined endpoint (composite of death, malignant ventricular arrhythmias, advanced atrioventricular block, cardiogenic shock, or reinfarction) within the first 24 hours.
Results: From the total population of the trial (N=270), 147 patients (54%) were recruited during out-of-hospital assistance and transferred to the primary angioplasty center (74 intravenous metoprolol and 73 controls). Infarct size was smaller in patients receiving intravenous metoprolol compared with controls (23.4 [SD 15.0] versus 34.0 [SD 23.7] g; adjusted difference -11.4; 95% confidence interval [CI] -18.6 to -4.3). Left ventricular ejection fraction was higher in the intravenous metoprolol group (48.1% [SD 8.4%] versus 43.1% [SD 10.2%]; adjusted difference 5.0; 95% CI 1.6 to 8.4). Metoprolol administration did not increase the incidence of the prespecified safety combined endpoint: 6.8% versus 17.8% in controls (risk difference -11.1; 95% CI -21.5 to -0.6).
Conclusion: Out-of-hospital administration of intravenous metoprolol by EMS within 4.5 hours of symptom onset in our subjects reduced infarct size and improved left ventricular ejection fraction with no excess of adverse events during the first 24 hours.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.annemergmed.2014.07.010 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Metoprolol vs diltiazem for atrial fibrillation with rapid ventricular rate: Systematic review and meta-analysis of adverse events.
Am J Emerg Med
December 2024
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Departments of Pharmacy and Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA. Electronic address:
Background: Intravenous (IV) diltiazem and metoprolol are commonly used to achieve rate control for atrial fibrillation with RVR (Afib with RVR), and are both recommended as first-line by current guidelines. While prior studies investigated the efficacy of these medications, there is little evidence available regarding the risk of adverse events (AEs) with their use.
Methods: We identified randomized controlled trials (RCT) and observational studies reporting rates of AEs following administration of IV diltiazem and metoprolol for Afib with RVR by searching PubMed, SCOPUS, EMBASE, and Cochrane Library.
Evaluation of the Effect of Risankizumab on the Pharmacokinetics of Cytochrome P450 Substrates in Patients with Moderately to Severely Active Ulcerative Colitis or Crohn's Disease.
Clin Pharmacokinet
December 2024
Clinical Pharmacology, AbbVie Inc., Dept R4PK, Bldg AP31-3, 1 North Waukegan Road, North Chicago, IL, 60064-1802, USA.
Background And Objective: The objective of this study was to characterize the effects of risankizumab on the pharmacokinetics of cytochrome P450 (CYP) 1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A substrates in patients with moderately to severely active Crohn's disease (CD) or ulcerative colitis (UC) using a cocktail approach.
Methods: Patients with CD or UC (n = 20) received single doses of probe substrates for CYP1A2 (caffeine 100 mg), CYP2C9 (warfarin 10 mg), CYP2C19 (omeprazole 20 mg), CYP2D6 (metoprolol 50 mg), and CYP3A (midazolam 2 mg) before and after intravenous infusions of risankizumab 1800 mg once every 4 weeks for four doses. Serial blood samples were collected for determination of concentrations of the CYP probe drugs and metabolites with and without risankizumab.
Sympathetic nerve activity and response to physiological stress in Takotsubo syndrome.
Clin Auton Res
November 2024
Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Purpose: The prevailing hypothesis posits that Takotsubo syndrome (TTS) is caused by massive sympathetic activation, yet supporting evidence remains inconsistent. The objectives of the present study were to determine whether sympathetic activity and reactivity are enhanced in the recovery phase of TTS, and to evaluate the effect of selective β1-receptor blockade on sympathetic reactivity.
Methods: We conducted a case-control study that included 18 female patients with TTS and 13 age- and sex-matched controls.
Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review.
J Pediatr Pharmacol Ther
October 2024
Department of Pharmacy (TMA), Le Bonheur Children's Hospital, Memphis TN.
Postural orthostatic tachycardia syndrome (POTS) is a chronic illness with unknown mortality and high morbidity, often diagnosed in the adolescent years. Published literature regarding POTS primarily focuses on the adult population, and guidance on treatment in pediatrics is sparse. The purpose of this clinical review is to evaluate the current literature on the management of POTS in pediatric patients.
View Article and Find Full Text PDFEfficacy and Safety of Intravenous Diltiazem Versus Metoprolol in the Management of Atrial Fibrillation with Rapid Ventricular Response in the Emergency Department: A Comprehensive Umbrella Review of Systematic Reviews and Meta-analyses.
J Innov Card Rhythm Manag
September 2024
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Article Synopsis
- Atrial fibrillation (AF) is a common heart rhythm disorder in the U.S. that affects millions, and it can lead to serious complications like rapid ventricular response (RVR).
- An umbrella review of existing systematic reviews found IV diltiazem was more effective than IV metoprolol for controlling heart rate and reducing ventricular rates in patients experiencing AF with RVR.
- However, the use of IV diltiazem was also associated with a higher risk of hypotension, indicating the need for further research to evaluate the balance between efficacy and safety for these treatments.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!