The initial results of this trial were published a few months ago,* and showed that patients who received this treatment during emergency transit to hospital had much smaller amounts of dead heart muscle than those randomly assigned to receive no treatment. The new study shows that the proportion of patients with a severely deteriorated heart contractile function is much less (60%) in the group that received metoprolol. Early treatment with metoprolol treatment also significantly reduced the rate of hospital readmission for chronic heart failure, and massively reduced the need to implant a cardioverter-defibrillator.
Borja Ibáñez -- joint lead investigator on the study with Valentín Fuster -- explains that "the possibility to reduce so dramatically the number of cases of chronic heart failure (with all the associated treatments and hospital readmissions) with such a cheap procedure (the metoprolol treatment costs less than two euros per patient) could generate enormous savings for health services across Europe."
An initial estimate indicates that if half the heart-attack patients in Europe received early treatment with this cheap drug, the savings in treatment for heart failure alone could exceed €10 billion a year. But as Dr. Fuster is careful to emphasize, it is important to remain cautious, and these estimates will need to be confirmed in a much larger study population across Europe. The research team is already preparing a new clinical trial, with more than 3000 patients in several European countries, which will be powered to demonstrate a reduction in mortality with this treatment. According to the authors, "The results presented today and published simultaneously in this issue of JACC are unprecedented and extremely promising, but rigorous clinical investigation requires corroboration in an independent population." The European consortium for this larger scale study, which will be led from Spain by the CNIC, is already being formed, and includes researchers from Belgium, the Netherlands, Germany, France, Denmark, Serbia, Poland, Sweden, and the United Kingdom.
Dr. Gonzalo Pizarro, one of the first authors on the study, comments that "it has been possible to demonstrate the beneficial and sustained effect of this acute treatment thanks to the realization of advanced cardiac magnetic resonance analysis of almost all the patients in this clinical trial." The CNIC is recognized for its expertise and research in different imaging technologies, particularly magnetic resonance imaging. The center runs a range of training programs in cardiovascular imaging in collaboration with the Mount Sinai School of Medicine, which is also directed by Dr. Fuster. Many of the cardiologists who contributed to the design, performance and analysis of the MRI scans in the METOCARD-CNIC trial, including Drs. Pizarro and Fernández-Friera (joint first authors on the study), received training on these programs, and now work at the CNIC, combining their research activity and their clinical work in the Spanish hospital network.
The above story is based on materials provided by Centro Nacional de Investigaciones Cardiovasculares. Note: Materials may be edited for content and length.
- Gonzalo Pizarro, Leticia Fernández-Friera, Valentin Fuster, Rodrigo Fernández-Jiménez, José M. García-Ruiz, Ana García-Álvarez, Alonso Mateos, María V. Barreiro, Noemí Escalera, Maite D. Rodriguez, Antonio de Miguel, Inés García-Lunar, Juan J. Parra-Fuertes, Javier Sánchez-González, Luis Pardillos, Beatriz Nieto, Adriana Jiménez, Raquel Abejón, Teresa Bastante, Vicente Martínez de Vega, José A. Cabrera, Beatriz López-Melgar, Gabriela Guzman, Jaime García-Prieto, Jesús G. Mirelis, José Luis Zamorano, Agustín Albarrán, Javier Goicolea, Javier Escaned, Stuart Pocock, Andrés Iñiguez, Antonio Fernández-Ortiz, Vicente Sánchez-Brunete, Carlos Macaya, Borja Ibanez. Long term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: results from the METOCARD-CNIC trial. Journal of the American College of Cardiology, 2014; DOI: 10.1016/j.jacc.2014.03.014
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