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ACC 2014:早期静脉用β阻滞剂或可减少STEMI患者梗死面积

2014-04-04 cath 编译 医学论坛网

2014年美国心脏病学会年会(ACC 2014)公布的METOCARD-CNIC研究表明,在直接行经皮冠状动脉介入(PCI)治疗的ST段抬高性心肌梗死(STEMI)患者中,早期静脉应用β阻滞剂与5-7天时梗死面积减少有相关性,这进而改善了患者6个月时的左心室射血分数。虽然该研究的临床终点不够有力,但在美托洛尔组中,有不良心血管事件减少的有利趋势。 该随机平行分层研究纳入270例患者,平均年龄为5

2014年美国心脏病学会年会(ACC 2014)公布的METOCARD-CNIC研究表明,在直接行经皮冠状动脉介入(PCI)治疗的ST段抬高性心肌梗死(STEMI)患者中,早期静脉应用β阻滞剂与5-7天时梗死面积减少有相关性,这进而改善了患者6个月时的左心室射血分数。虽然该研究的临床终点不够有力,但在美托洛尔组中,有不良心血管事件减少的有利趋势。

该随机平行分层研究纳入270例患者,平均年龄为59岁,男性占86%,合并糖尿病患者占23%,平均体质指数28 kg/m2,合并糖尿病患者占23%,招募时的平均收缩压为143 mm Hg,82%的患者接受阿司匹林治疗。应用美托洛尔至少一个剂量、两个剂量和三个剂量的百分比分别为99%、82%和67%。随访时间为7天和6个月,主要终点为5—7天时患者心肌梗死面积。

结果显示,静脉应用β阻滞剂组和对照组在5—7天时的梗死面积分别为25.6 g和32.0 g(校正P值为0.012)。在闭塞梗死动脉干预前的患者中观察到这种获益,而在那些已再灌注动脉中并未见到;两组的左心室射血分数分别为46.1%和43.4%(校正P值为0.045);24小时严重不良心脏事件发生率分别为7.1%和12.3%(P = 0.21)。6个月时,两组的平均左心室射血分数分别为49%和45%(P= 0.025)。美托洛尔组有置入除颤器适应证的患者更少(P= 0.012)。2年时,美托洛尔组和对照组的死亡、因心力衰竭入院、再次心肌梗死和恶化型心律失常的复合事件分别为10.8%和18.3%(P= 0.065)。

原始出处:


Ibanez B1, Macaya C, Sánchez-Brunete V, Pizarro G, Fernández-Friera L, Mateos A, Fernández-Ortiz A, García-Ruiz JM, García-Álvarez A, Iñiguez A, Jiménez-Borreguero J, López-Romero P, Fernández-Jiménez R, Goicolea J, Ruiz-Mateos B, Bastante T, Arias M, Iglesias-Vázquez JA, Rodriguez MD, Escalera N, Acebal C, Cabrera JA, Valenciano J, Pérez de Prado A, Fernández-Campos MJ, Casado I, García-Rubira JC, García-Prieto J, Sanz-Rosa D, Cuellas C, Hernández-Antolín R, Albarrán A, Fernández-Vázquez F, de la Torre-Hernández JM, Pocock S, Sanz G, Fuster V.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 Oct 1;128(14):1495-503. doi: 10.1161/CIRCULATIONAHA.113.003653. 

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    2014-07-27 zhyy88
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    2014-04-22 fusion
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    2014-04-07 8.35.201.41

    关键早到什么时候?如果使用时间点不当,会不会加重STEMI?

    0

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