Temas Livres do LIII Congresso Brasileiro de Cardiologia

TL 375

Lelio A. Silva, Expedito E. Ribeiro, Antonia Petrizzo, Mila Yugar, Izabela J. Guedes, Renata C. Duprat, Mario L. Baptista Fº, João A. Mattar, José R. Tavares, Agenor Reis Fº, Rinaldo Carneiro.

Hospital Unicor - São Paulo - Brazil

Introduction: Although beta-blockade following acute myocardial infarction(AMI) is frequently practiced, their early effects are not yet fully explored and judged. The aim of this prospective and randomized study was to appraise the efficacy of early and short-term treatment using metoprolol in AMI, immediately after thrombolytic therapy(TT).

Methods: During a 24 months period (Jan 95 to Dec. 96), we evaluated 191 consecutive patients (p) with AMI after TT. There were 145 males and 46 females with age mean 60± 11. Sixty four p not selected to receive beta-blockers (contraindication) were excluded from the study, and the remaining 127 p were randomized to received metoprolol (Group A, n= 68; 53,5%) or not (Group B= 59; 46,5%). Metoprolol was used as 15mg intravenously, follwed by 100-200mg daily, taken orally. Both groups remained in close clinical observation and underwent cardiac catheterization after 96± 40hs from the diagnosis of AMI. Peak CKMB was selected from serial determinations, recurrent ischemia was clinically identified, and TIMI grade, collateral circulation , and left ventricular ejection fraction (LVEF) were obtained by cardiac catheterization.

Results: Data were mean ± SD. Statistics done by analysis of variance

Variable Gender/Unit/Study Group A Group B p value

Sex Male/Female 56/12 44/15 0.457

Age Yr. 57± 10 62± 13 0.016

Peak CKMB UI 98± 78 96± 72 0.886

Rec.ischemia Clinical 9/68(13%) 14/59(24%) 0.169

TIMI II or III 47/66(71%) 43/54(80%) 0.357

C. circulation Angioghraphy 15/66(23%) 8/53(15%) 0.388

LVEF % 57± 13,n=64 57± 15,n=52 1.000

Conclusions: Within the limits of the protocol adopted in this study, we were unable to demonstrate that early metoprolol therapy after TT in AMI

decrease the episodes of recurrent ischemia, variation in the related arterial patency (TIMI II - III), and decrease in the infarcted area.