High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: Efficacy and safety

Raju, V.M.; Gosling, O; Morgan-Hughes, G J; Colliver, Robert; Iyengar, Srikanth; Dissanayake, PV; Roobottom, Carl

doi:10.1016/j.crad.2014.03.003

“…The average metoprolol dose was 20 mg (maximum: 70 mg). Complications were seen in 10 (1.47 %) patients, with the complications requiring intervention in only 3 (0.44 %) patients 99 . The complications included a second-degree atrioventricular block in two patients.…”

Section: Patient Safetymentioning

confidence: 99%

“…2 ) kam es in mehreren großen Studien zu keinen klinisch relevanten Komplikationen. Raju et al haben retrospektiv die Daten von 662 Patienten auswerten können, die im Mittel 19 mg Metroprolol (Maximum 67 mg) bis zum Erreichen der Zielherzfrequenz unter 60 Schläge pro Minute erhalten haben 99 . Hier zeigten sich keine unerwünschten Wirkungen.…”

Section: Patientensicherheitunclassified

“…Ähnliches berichten Kassamali et al von 679 Patienten, bei denen eine CT-Koronarangiografie durchgeführt wurde. Hier lag die mittlere Dosis Metoprolol bei 20 mg (Maximum: 70 mg), bei 10 (1,47 %) Patienten kam es zu Komplikationen, wobei dies lediglich bei 3 (0,44 %) Patienten interventionsbedürftige Komplikationen waren 99 . Zu diesen Komplikationen gehörte bei 2 Patienten ein atrioventrikulärer Block zweiten Grades.…”

Section: Patientensicherheitunclassified

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German Radiological Society and the Professional Association of German Radiologists Position Paper on Coronary computed tomography: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome

Langenbach

¹

,

Sandstede²,

Sieren

³

et al. 2023

Rofo

2

0

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This position paper is a joint statement of the German Radiological Society (DRG) and the Professional Association of German Radiologists (BDR), which reflects the current state of knowledge about coronary computed tomography. It is based on preclinical and clinical studies that have investigated the clinical relevance as well as the technical requirements and fundamentals of cardiac computed tomography. Citation Format

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“…This has led to the use of several alternate regimens including intravenous metoprolol, other beta-blockers such as atenolol, ivabradine, or calcium channel blockers. 14,15 Nevertheless intravenous metoprolol, the most commonly used parenteral beta-blocker, has demonstrated limited efficacy in lowering HR. Ivabradine has been suggested as an alternative to betablockers.…”

Section: Discussionmentioning

confidence: 99%

Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography

Rosa

¹

,

Ramos

²

,

Marques

³

et al. 2016

Revista Portuguesa de Cardiologia (English Edition)

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Objective: To evaluate the efficacy and safety of a heart rate (HR) reduction protocol using intravenous esmolol as bailout for failed oral metoprolol regimens in patients undergoing coronary computed tomography angiography (CCTA) with 64-slice multidetector computed tomography (64-MDCT). Methods: Patients who underwent cardiac 64-MDCT in a single institution between 2011 and 2014 were analyzed. Those with HR above 60 beats per minute (bpm) on presentation received oral metoprolol (50-200 mg) at least one hour before CCTA. Intravenous esmolol 1-2 mg/kg was administered as a bolus whenever HR remained over 65 bpm just before imaging. The primary efficacy endpoint was HR <65 bpm during CCTA. The primary safety endpoint was symptomatic hypotension or bradycardia up to hospital discharge. Results: During the study period CCTA was performed in 947 cases. In 86% of these, oral metoprolol was the only medication required to successfully reduce HR <60 bpm. Esmolol was used in the remaining 130 patients (14%). For esmolol-treated patients mean baseline and acquisition HR were 74±14 bpm and 63±9 bpm, respectively (p<0.001). The target HR of <65 bpm was achieved in 82 of the 130 esmolol-treated patients (63%). Considering the whole population, esmolol use led to a significant increase in the primary efficacy endpoint from 86% to 95% (p<0.001). Esmolol also resulted in a statistically, but not clinically, significant reduction in systolic blood pressure (144±22 to 115±17 mmHg; p<0.001). The combined primary safety endpoint was only observed in two (1.5%) patients. Conclusion: Despite optimal use of oral beta-blockers, 14% of patients needed intravenous esmolol for HR control. The pre-medication combination of oral metoprolol and on-demand administration of intravenous esmolol was safe and effective and enabled 95% of patients to be imaged with HR below 65 bpm. Document downloaded from http://www.elsevier.es, day 21/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 21/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Conclusão: Apesar da utilização sistemática de betabloqueante oral, 14% dos casos necessitaram de esmolol endovenoso para controlo adequado de FC. Pré-medicação combinada de metoprolol oral e esmolol endovenoso quando necessária foi segura e eficaz, e permitiu que 95% dos doentes apresentassem FC <65 bpm no momento da aquisição de imagem. S. Aguiar Rosa et al. PALAVRAS-CHAVE

show abstract

“…This has led to the use of several alternate regimens including intravenous metoprolol, other beta-blockers such as atenolol, ivabradine, or calcium channel blockers. 14,15 Nevertheless intravenous metoprolol, the most commonly used parenteral beta-blocker, has demonstrated limited efficacy in lowering HR.…”

Section: Discussionmentioning

confidence: 99%

Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography

Rosa

¹

,

Ramos

²

,

Marques

³

et al. 2016

Revista Portuguesa de Cardiologia

3

0

View full text Add to dashboard Cite

Objective: To evaluate the efficacy and safety of a heart rate (HR) reduction protocol using intravenous esmolol as bailout for failed oral metoprolol regimens in patients undergoing coronary computed tomography angiography (CCTA) with 64-slice multidetector computed tomography (64-MDCT). Methods: Patients who underwent cardiac 64-MDCT in a single institution between 2011 and 2014 were analyzed. Those with HR above 60 beats per minute (bpm) on presentation received oral metoprolol (50-200 mg) at least one hour before CCTA. Intravenous esmolol 1-2 mg/kg was administered as a bolus whenever HR remained over 65 bpm just before imaging. The primary efficacy endpoint was HR <65 bpm during CCTA. The primary safety endpoint was symptomatic hypotension or bradycardia up to hospital discharge. Results: During the study period CCTA was performed in 947 cases. In 86% of these, oral metoprolol was the only medication required to successfully reduce HR <60 bpm. Esmolol was used in the remaining 130 patients (14%). For esmolol-treated patients mean baseline and acquisition HR were 74±14 bpm and 63±9 bpm, respectively (p<0.001). The target HR of <65 bpm was achieved in 82 of the 130 esmolol-treated patients (63%). Considering the whole population, esmolol use led to a significant increase in the primary efficacy endpoint from 86% to 95% (p<0.001). Esmolol also resulted in a statistically, but not clinically, significant reduction in systolic blood pressure (144±22 to 115±17 mmHg; p<0.001). The combined primary safety endpoint was only observed in two (1.5%) patients. Conclusion: Despite optimal use of oral beta-blockers, 14% of patients needed intravenous esmolol for HR control. The pre-medication combination of oral metoprolol and on-demand administration of intravenous esmolol was safe and effective and enabled 95% of patients to be imaged with HR below 65 bpm. Document downloaded from http://www.elsevier.es, day 21/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 21/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Conclusão: Apesar da utilização sistemática de betabloqueante oral, 14% dos casos necessitaram de esmolol endovenoso para controlo adequado de FC. Pré-medicação combinada de metoprolol oral e esmolol endovenoso quando necessária foi segura e eficaz, e permitiu que 95% dos doentes apresentassem FC <65 bpm no momento da aquisição de imagem. S. Aguiar Rosa et al. PALAVRAS-CHAVE

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High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: Efficacy and safety

Cited by 12 publications

References 15 publications

German Radiological Society and the Professional Association of German Radiologists Position Paper on Coronary computed tomography: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome

German Radiological Society and the Professional Association of German Radiologists Position Paper on Coronary computed tomography: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome

Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography

Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography

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