Early Metoprolol Administration before Primary Percutaneous Coronary Intervention (PCI) in ST-Segment Elevation Myocardial Infarction: Impact on Left Ventricular Ejection Fraction

Muhammad  Amin; Tariq  Nawaz; Sadam  Hussain; Syed Muhammad  Nayab Ali; Faisal Saleh  Hayat

doi:10.54112/bcsrj.v6i6.1809

Authors

Muhammad Amin Department of Cardiology, Lady Reading Hospital Peshawar, Pakistan
Tariq Nawaz Department of Cardiology, Lady Reading Hospital Peshawar, Pakistan
Sadam Hussain Department of Cardiology, Lady Reading Hospital Peshawar, Pakistan
Syed Muhammad Nayab Ali Department of Cardiology, Lady Reading Hospital Peshawar, Pakistan
Faisal Saleh Hayat Department of Cardiology, Lady Reading Hospital Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.1809

Keywords:

Metoprolol; Primary Percutaneous Coronary Intervention; ST-Segment Elevation Myocardial Infarction; Left Ventricular Ejection Fraction

Abstract

Ischemic heart disease is the main cause of death globally, with STEMI being its most severe sign. Beta-blocker lower systemic blood pressure, heart rate, decreases ischemia damage when given before PPCI, particularly when metoprolol is used. Objective: the aim of this study was to find out the effect of early metoprolol administration before Primary Percutaneous Coronary Intervention (PCI) in STEMI. Methods: The current Randomized Controlled Trial was carried out at the Department of Cardiology, Lady Reading Hospital, Peshawar from 1st February 2025 to 31st April after taking permission from the ethical committee of the institute. A total of 60 participants were included and divided in to two groups and each group had 30 individuals. All collected data was entered into a computerized database, and SPSS version 25.0 was used for data analysis. To compare the effectiveness of early metoprolol administration before PCI in ST-segment elevation myocardial infarction on LVEF, an independent sample t-test was used to compare the mean LVEF values between the treatment group and the control group. A p-value of <0.05 were considered statistically significant. Results: Over all 60 individuals participated in the current study. The LVEF of metoprolol group was substantially higher than the control group at one week, three months, and 6 months following PCI (P <0.05). Before starting therapy, the two groups' LVEFs did not differ significantly (P >0.05). The intravenous metoprolol group's LVEF was considerably greater than the control group's at one week, three months, and six months following PCI. The Intravenous Metoprolol group's 6 months overall incidence of MACE was noticeably lower than the control groups. Conclusion: The current study concluded that in individuals with ST-Segment Elevation Myocardial Infarction early metoprolol administration before Primary Percutaneous Coronary Intervention (PCI) in ST-Segment Elevation Myocardial Infarction increase left ventricular ejection, can improve heart rate regulation, lessen myocardial damage, and enhance cardiac function and lower the risk of serious adverse cardiac events.

Downloads

Download data is not yet available.

References

Jalbani FA, Shaikh S, Fatima S. Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi. Pakistan Journal of Medical Sciences. 2020;36(5):914.2. Mongkhon P, Dilokthornsakul P, Tepwang K, Tapanya K, Sopitprasan C, Chaliawsin P, et al. The effects of fibrinolytic before referring STEMI patients: A systematic review and meta-analysis. IJC Heart & Vasculature. 2017;15:9-14.

Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P, et al. Acute myocardial infarction: changes in patient characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation. 2017;136(20):1908-19.

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal. 2018;39(2):119-77.

Motawea KR, Gaber H, Singh RB, Swed S, Elshenawy S, Talat NE, et al. Effect of early metoprolol before PCI in ST‐segment elevation myocardial infarction on infarct size and left ventricular ejection fraction. A systematic review and meta‐analysis of clinical trials. Clinical Cardiology. 2022;45(10):1011-28.

García-Prieto J, Villena-Gutiérrez R, Gómez M, Bernardo E, Pun-García A, García-Lunar I, et al. Neutrophil stunning by metoprolol reduces infarct size. Nature communications. 2017;8(1):14780.

Ibanez B, Macaya C, Sánchez-Brunete V, Pizarro G, Fernández-Friera L, Mateos A, et al. Effect of early metoprolol on infarct size in ST-segment–elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: the effect of metoprolol in cardioprotection during an acute myocardial infarction (METOCARD-CNIC) trial. Circulation. 2013;128(14):1495-503.

Mateos A, García-Lunar I, García-Ruiz JM, Pizarro G, Fernández-Jiménez R, Huertas P, et al. Efficacy and safety of out-of-hospital intravenous metoprolol administration in anterior ST-segment elevation acute myocardial infarction: insights from the METOCARD-CNIC trial. Annals of Emergency Medicine. 2015;65(3):318-24.

Pizarro G, Fernández-Friera L, Fuster V, Fernández-Jiménez R, García-Ruiz JM, García-Álvarez A, et al. Long-term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: results from the METOCARD-CNIC trial (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction). Journal of the American College of Cardiology. 2014;63(22):2356-62.

Group MTR. Metoprolol in acute myocardial infarction (MIAMI). A randomised placebo-controlled international trial. European Heart Journal. 1985;6(3):199-226.

Members ATF, Steg PG, James SK, Atar D, Badano LP, Lundqvist CB, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European heart journal. 2012;33(20):2569-619.

Hearse D, Yellon D, Downey J. Can beta blockers limit myocardial infarct size? European heart journal. 1986;7(11):925-30.

Ibanez B, Prat-González S, Speidl WS, Vilahur G, Pinero A, Cimmino G, et al. Early metoprolol administration before coronary reperfusion results in increased myocardial salvage: analysis of ischemic myocardium at risk using cardiac magnetic resonance. Circulation. 2007;115(23):2909-16.

Larose E, Rodés-Cabau J, Pibarot P, Rinfret S, Proulx G, Nguyen CM, et al. Predicting late myocardial recovery and outcomes in the early hours of ST-segment elevation myocardial infarction: traditional measures compared with microvascular obstruction, salvaged myocardium, and necrosis characteristics by cardiovascular magnetic resonance. Journal of the American College of Cardiology. 2010;55(22):2459-69.

Gerbaud E, Montaudon M, Chasseriaud W, Gilbert S, Cochet H, Pucheu Y, et al. Effect of ivabradine on left ventricular remodelling after reperfused myocardial infarction: a pilot study. Archives of Cardiovascular Diseases. 2014;107(1):33-41.

Barillà F, Pannarale G, Torromeo C, Paravati V, Acconcia MC, Tanzilli G, et al. Ivabradine in patients with ST-elevation myocardial infarction complicated by cardiogenic shock: a preliminary randomized prospective study. Clinical drug investigation. 2016;36:849-56.

Xu Y, Zhang W, Zhong X, Yan S, Chen H, Guo R, et al. Effect of early use of ivabradine on left ventricular remodeling after primary percutaneous coronary intervention in patients with acute ST‐segment elevation myocardial infarction: A pilot test. Annals of Noninvasive Electrocardiology. 2021;26(2):e12816.

Rezq A, Saad M, Al Mahmoudy A, El Nozahi M. Value of Ivabradine in patients with anterior ST-Elevation myocardial infarction: the VIVA-STEMI study. Cardiology and Cardiovascular Medicine. 2020;4(6):630-9.

Oleynikov V, Dushina E, Golubeva A, Barmenkova JA. Early predictors of heart failure progression in patients after myocardial infarction. Kardiologiia. 2020;60(11):84–93.

Heusch G, Skyschally A, Gres P, van Caster P, Schilawa D, Schulz R. Improvement of regional myocardial blood flow and function and reduction of infarct size with ivabradine: protection beyond heart rate reduction. European heart journal. 2008;29(18):2265-75.