Coronary Heart Disease

Abstract

Background-The effect of β-blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). Methods and Results-Patients with Killip class II or less anterior ST-segment-elevation myocardial infarction (STEMI)undergoing percutaneous coronary intervention within 6 hours of symptoms onset were randomized to receive intravenous metoprolol (n=131) or not (control, n=139) before reperfusion. All patients without contraindications received oral metoprolol within 24 hours. The predefined primary end point was infarct size on magnetic resonance imaging performed 5 to 7 days after STEMI. Magnetic resonance imaging was performed in 220 patients (81%). Mean±SD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.6±15.3 versus 32.0±22.2 g; adjusted difference, −6.52; 95% confidence interval, −11.39 to −1.78; P=0.012). In patients with pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 0 to 1 flow, the adjusted treatment difference in infarct size was −8.13 (95% confidence interval, −13.10 to −3.16; P=0.0024). Infarct size estimated by peak and area under the curve creatine kinase release was measured in all study populations and was significantly reduced by intravenous metoprolol. Left ventricular ejection fraction was higher in the intravenous metoprolol group (adjusted difference, 2.67%; 95% confidence interval, 0.09-5.21; P=0.045). The composite of death, malignant ventricular arrhythmia, cardiogenic shock, atrioventricular block, and reinfarction at 24 hours in the intravenous metoprolol and control groups was 7.1% and 12.3%, respectively (P=0.21). Conclusions-In patients with anterior Killip class II or less ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI.

Virtual Care for Indigenous Populations in Canada, the United States, Australia, and New Zealand: Protocol for a Scoping Review

“…T. Smith & Ruiz, 2002;Sullivan, et al, 1999). A number of studies support the notion of a gradient between the magnitude of depression and future cardiac events, suggesting that risk for coronary artery disease associated with depression exists along a continuum, with the relative risk depending on the magnitude of depressive symptoms (Glassman & Shapiro, 1998;Rozanski, et al, 1999).…”

“…One study found an increased risk for cardiac mortality or MI among 72% of its participants reporting only two symptoms of depression, a level of depression insufficient to diagnose major or even minor depression (Horsten, Mittleman, Wamala, Schenck-Gustafsson, & Orth-Gomér, 2000). Among those who have suffered a heart attack higher levels of depression or anxiety is associated with increased mortality and morbidity, poor emotional recovery, lack of short term improvement, and longer latency to normal levels of activity (P. Bennett & Carroll, 1997;Gorkin, Follick, Wilkin, & Niaura, 1994;Pratt, et al, 1996;T. Smith & Ruiz, 2002).…”