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Due caution using early β-blockers for acute myocardial infarction

机译：使用早期β受体阻滞剂治疗急性心肌梗塞时应谨慎

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CitationChen ZM, Pan HC, Chen YP, Peto R, Collins R, Jiang LX, Xie JX, Liu LS. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366:1622–1632 [1].BackgroundDespite previous randomised trials of early β-blocker therapy in the emergency treatment of myocardial infarction (MI), uncertainty has persisted about the value of adding it to current standard interventions (e.g., aspirin and fibrinolytic therapy), and the balance of potential benefits and hazards is still unclear in high-risk patients.MethodsDesign and settingProspective blinded randomized controlled trial in 1250 hospitals in China.Subjects45,852 patients admitted within 24 h of suspected acute MI onset. 93% had ST-segment elevation or bundle branch block, and 7% had ST-segment depression.InterventionSubjects were randomly allocated metoprolol (up to 15 mg intravenous then 200 mg oral daily; n = 22,929) or matching placebo (n = 22,923). Treatment was to continue until discharge or up to 4 weeks in hospital (mean 15 days in survivors) and 89% completed it.OutcomesThe two pre-specified co-primary outcomes were: (1) composite of death, reinfarction, or cardiac arrest; and (2) death from any cause during the scheduled treatment period. Comparisons were by intention to treat, and used the log-rank method. This study is registered with ClinicalTrials.gov, number NCT 00222573.
机译：引用文献陈ZM，潘慧聪，陈玉平，Peto R，Collins R，姜丽霞，谢建勋，刘丽霞。在45852例急性心肌梗死患者中，先静脉注射然后口服美托洛尔：随机安慰剂对照试验。 Lancet 2005; 366：1622–1632 [1]。背景尽管先前曾有针对早期β受体阻滞剂治疗心肌梗死（MI）的随机试验，但仍不确定将其添加到当前标准干预措施（例如阿司匹林）中的价值。方法和设计，前瞻性在中国1250家医院进行的前瞻性双盲随机对照试验。对象45,852名患者在疑似急性MI发作后24小时内入院。 93％的患者出现ST段抬高或束支传导阻滞，7％的患者出现ST段压低，干预对象被随机分配美托洛尔（最多15 mg静脉滴注，然后每天200 mg口服; n = 22,929）或匹配的安慰剂（n = 22,923） 。治疗应一直持续到出院或住院4周（幸存者平均15天）并完成89％。结局两项预先确定的主要共同结果是：（1）死亡，再梗塞或心脏骤停的综合症状; （2）在预定治疗期内因任何原因死亡。比较是按意向进行处理，并使用对数秩方法。该研究已在ClinicalTrials.gov上注册，编号为NCT 00222573。

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