Reopening the Case for Routine IV Beta Blockers in STEMI

Prehospital IV metoprolol was beneficial in selected patients with STEMI.

After publication of the COMMIT trial results in 2005, intravenous (IV) beta blockers were no longer recommended as routine therapy in the initial care of patients with ST-segment-elevation myocardial infarction (STEMI; NEJM JW Cardiol Dec 16 2005). In a planned secondary analysis of a Spanish trial, investigators report outcomes for 147 patients with STEMI who were randomized to receive three 5-mg doses of IV metoprolol or no metoprolol in the prehospital setting within 4.5 hours of symptom onset. Patients with left bundle branch block or Killip class III or IV congestive heart failure were excluded. About 40% of patients had hypertension.

On cardiac magnetic resonance imaging 1 week after infarction, patients who received metoprolol had sm…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Reopening the Case for Routine IV Beta Blockers in STEMI

Topics

Reviewing Author