Key result
Inability to perform predischarge stress testing (RR 1.40; 95% CI 1.10-1.78; P=0.01) and low exercise capacity predicted 4-year mortality and non-fatal MI, unaffected by acute metoprolol therapy.
Why the study?
Does acute administration of intravenous metoprolol influence the ability of predischarge exercise test data to predict long-term mortality and non-fatal MI in patients with suspected acute MI?
RCT (n=190)
placebo-controlled
randomized
Does acute administration of intravenous metoprolol influence the ability of predischarge exercise test data to predict long-term mortality and non-fatal MI in patients with suspected acute MI?
Effect estimate: RR 1.40 (95% CI 1.10-1.78)
Absolute Event Rate: 79.5% vs 56.9%
p-value: p=0.01
Predischarge exercise capacity and the ability to perform stress testing are independent predictors of 4-year mortality and non-fatal MI in patients with suspected acute MI, and this prognostic value is not altered by acute beta-blockade with metoprolol.
Predischarge stress testing retains prognostic value for 4-year outcomes after suspected MI despite acute metoprolol; confirms its reliability for risk stratification.
To evaluate the influence of acute beta-blockade on the ability of predischarge exercise test data to predict long-term prognosis in patients admitted for suspected acute myocardial infarction, patients randomized at hospital admission to intravenous metoprolol or placebo were studied. Among 190 patients discharged alive, total 4-year mortality was 20.5% (n = 39); (33 cardiac deaths, 6 non-cardiac deaths). Non-fatal infarction rate was 6.8% (n = 13). Multiple logistic regression analysis revealed that total mortality and non-fatal infarctions were independently predicted by (a) inability to perform predischarge stress testing (event-free survival for patients exercise tested 79.5% vs 56.9% for patients not eligible for testing; relative risk (RR) 1.40, 95% confidence interval (CI) 1.10-1.78; P = 0.01), and (b) low predischarge exercise capacity (RR 1.44, CI 1.08-1.93; P = 0.034). ST segment shift > or = 1 mm did not predict mortality or reinfarction. Administration of metoprolol in the acute phase did not influence the predictive value of these parametres. It is concluded that assessment of exercise capacity at early exercise testing yields independent information for later death and myocardial infarctions, and that beta-blockade with metoprolol does not influence the predictive value of early exercise testing.
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Rønnevik et al. (1992) conducted an RCT in suspected acute myocardial infarction (n=190). Intravenous metoprolol and predischarge stress testing vs. Placebo and inability to perform stress testing was evaluated on event-free survival (total mortality and non-fatal infarctions) (RR 1.40, 95% CI 1.10-1.78, p=0.01). Inability to perform predischarge stress testing (RR 1.40; 95% CI 1.10-1.78; P=0.01) and low exercise capacity predicted 4-year mortality and non-fatal MI, unaffected by acute metoprolol therapy.
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