Key result
Standard metoprolol dosing proves feasible in Chinese ACS patients, with ~29% achieving target discharge doses.
Why the study?
To evaluate the feasibility and tolerability of the metoprolol standard dosing pathway in Chinese patients with ACS.
Does the metoprolol standard dosing pathway achieve target dosing safely in Chinese patients with acute coronary syndrome?
Does the metoprolol standard dosing pathway achieve target dosing safely in Chinese patients with acute coronary syndrome?
The metoprolol standard dosing pathway is feasible and well-tolerated in Chinese patients with ACS, though only 29.46% achieved the target dose at discharge.
Target dose rarely met with metoprolol pathway in Chinese ACS; leaves open need for randomized titration trials.
OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway (MSDP) in Chinese patients with acute coronary syndrome (ACS). METHODS In this multicenter, prospective, open label, single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals. A total of 998 hospitalized patients aged ≥ 18 years and diagnosed with ACS were included. The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines. The primary endpoint was the percentage of patients achieving the target dose at discharge (V2). The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge (V4), and percentage of patients experiencing bradycardia (heart rate < 50 beats/min), hypotension (blood pressure < 90/60 mmHg) and transient cardiac dysfunction at V2 and V4. RESULTS Of the 998 patients, 29.46% of patients achieved the target dose (≥ 95 mg/d) at V2. The total population was divided into two groups: target group (patients achieving the target dose at V2) and non-target group (patients not achieving the target dose at V2). There was significant difference in the reduction of heart rate from baseline to discharge in the two groups (-4.97 ± 11.90 beats/min vs. -2.70 ± 9.47 beats/min, P = 0.034). There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2 (0 vs. 0, P = 1.000) and V4 (0.81% vs. 0.33%, P = 0.715). There was no significant difference in the proportion of hypotension between the two groups at V2 (0.004% vs. 0.004%, P = 1.000) and V4 (0 vs. 0.005%, P = 0.560). No transient cardiac dysfunction occurred in two groups during the study. A total of five adverse events (1.70%) and one serious adverse event (0.34%) were related to the pathway in target group. CONCLUSIONS In Chinese ACS patients, the feasibility and tolerability of the MSDP have been proved to be acceptable.
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Yin et al. (2023) studied acute coronary syndrome (n=998). metoprolol standard dosing pathway was evaluated on percentage of patients achieving the target dose at discharge. The metoprolol standard dosing pathway was feasible in Chinese patients with acute coronary syndrome, with 29.46% achieving the target dose (≥ 95 mg/d) at discharge.
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