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Randomized Controlled Trial
. 2020 Dec;7(2):e001316.
doi: 10.1136/openhrt-2020-001316.

Beta-blocker effect on ST-segment: a prespecified analysis of the EARLY-BAMI randomised trial

Enrico Fabris  1   2 , Renicus Hermanides  3 , Vincent Roolvink  3 , Borja Ibanez  4   5   6 , Jan Paul Ottervanger  3 , Gonzalo Pizarro  4   6   7 , Niels van Royen  8 , Alonso Mateos-Rodriguez  4   9 , Jan Henk Dambrink  3 , Agustin Albarran  10 , Francisco Fernández-Avilés  6   11   12 , Javier Botas  13 , Wouter Remkes  14 , Victoria Hernandez-Jaras  15 , Elvin Kedhi  16 , Jose Zamorano  6   17 , Fernando Alfonso  18 , Alberto García-Lledó  19 , Maarten van Leeuwen  3 , Robin Nijveldt  20 , Sonja Postma  21 , Evelien Kolkman  21 , Marcel Gosselink  3 , Bart de Smet  22 , Saman Rasoul  23   24 , Erik Lipsic  25 , Jan J Piek  26 , Valentin Fuster  4   27 , Arnoud Wj van 't Hof  23   24
Affiliations
Randomized Controlled Trial

Beta-blocker effect on ST-segment: a prespecified analysis of the EARLY-BAMI randomised trial

Enrico Fabris et al. Open Heart. 2020 Dec.

Abstract

Objective: The effect of early intravenous (IV) beta-blockers (BBs) administration in patients undergoing primary percutaneous coronary intervention (pPCI) on ST-segment deviation is unknown. We undertook a prespecified secondary analysis of the Early Beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction (EARLY-BAMI) trial to investigate the effect of early IV BB on ST-segment deviation.

Methods: The EARLY-BAMI trial randomised patients with ST-elevation myocardial infarction (STEMI) to IV metoprolol (2×5 mg bolus) or matched placebo before pPCI. The prespecified outcome, evaluated by an independent core laboratory blinded to study treatment, was the residual ST-segment deviation 1 hour after pPCI (ie, the percentage of patients with >3 mm cumulative ST deviation at 1 hour after pPCI).

Results: An ECG for the evaluation of residual ST-segment deviation 1 hour after pPCI was available in 442 out of 683 randomised patients. The BB group had a lower heart rate after pPCI compared with placebo (71.2±13.2 vs 74.3±13.6, p=0.016); however, no differences were noted in the percentages of patients with >3 mm cumulative ST deviation at 1 hour after pPCI (58.6% vs 54.1%, p=0.38, in BB vs placebo, respectively) neither a significant difference was found for the percentages of patients in each of the four prespecified groups (normalised ST-segment; 1-3 mm; 4-6 mm;>6 mm residual ST-deviation).

Conclusions: In patients with STEMI, who were being transported for primary PCI, early IV BB administration did not significantly affect ST-segment deviation after pPCI compared with placebo. The neutral result of early IV BB administration on an early marker of pharmacological effect is consistent with the absence of subsequent improvement of clinical outcomes.

Keywords: ST-T changes; STEMI; beta blockers; coronary intervention (PCI); reperfusion.

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Conflict of interest statement

Competing interests: The EARLY-BAMI trial is an investigator-initiated trial and registered at the Central Committee on Research Involving Human Subjects (Den Haag, The Netherlands) (www.ccmo.nl) with Central Committee on Research Involving Human Subjects no.: NL34300.075.10. CLINICAL TRIAL REGISTRATION: EudraCT Number: 2010-023394-19.

Figures

Figure 1
Figure 1
Patient flow. h, hour; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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