Anterior STEMI and multiform PVCs with Narrow Coupling Interval. When to give beta blockers in acute MI?

Conclusion of first report: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.Conclusion of 2nd report: In patients with anterior Killip class  ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer heart failure admissions.Interesting Discussion:" The results of the Clopidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT) trial are the main reason why clinical practice guidelines do not emphasize early intravenous β-blocker initiation in STEMI. In this trial, STEMI patients undergoing thrombolysis were randomized to early intravenous followed by oral metoprolol or matching placebo. The COMMIT trial did not report data on infarct size but showed significantly reduced rates of reinfarction and ventricular fibr illation in response to early intravenous metoprolol; however, this benefit came at the cost of excess cardiogenic shock, resulting in a net neutral effect on mortality. Although patients in COMMIT presented late (mean time from symptom onset to thrombolysis, 10.3 hours), mortality was lower in Kill ip class I and II patients receivi...

Source: Dr. Smith's ECG Blog - October 19, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs