Атеросклероз (Apr 2022)
Influence of injected metoprolol and high-dosage statin therapy on some markers of early myocardial remodeling in acute coronary syndrome
Abstract
Aim of the study was to evaluate of the effect of intravenous metoprolol tartrate administered before percutaneous coronary intervention (PCI), in combination with long-term use of high-dose atorvastatin, on dynamic changes in biochemical and ultrasound markers, as well as on the outcomes of early myocardial remodeling in patients with ST-segment elevation acute myocardial infarction (MI). Material and methods. A prospective randomized clinical trial included 136 patients with MI. The terms of the study were 35 ± 5 (from 30 to 40) days from the moment of admission to the hospital. The first group (control) included patients who received standard interventional and drug treatment at the hospital and outpatient post-infarction stages. The second group (exposure) included individuals who received a single intravenous injection of metoprolol tartrate before PCI, followed by a switch to oral metoprolol succinate on a systemic basis. These patients, as well as in the first group, regularly received all components of the basic drug therapy, including atorvastatin at a dose of 80 mg per day for one month from the onset of MI. On the 1st-2nd day of MI and a month later, plasma levels of biochemical biomarkers were assessed in patients; on the 1st, 10th day and one month later, ultrasound markers were evaluated using echocardiography. Upon the follow-up clinical outcomes of post-infarction myocardial remodeling were analyzed. Results. We confirmed that the use of a single intravenous injection of metoprolol tartrate (5–15 mg) in acute myocardial infarction before PCI against the background of high-dose atorvastatin (80 mg/day) for one month from the onset of myocardial infarction demonstrated convincing efficacy in relation to the prevention of early myocardial remodeling, which we assessed by the dynamics of ultrasound markers, as well as by the plasma activity of all three key biochemical markers in comparison with the control group of patients. Conclusions. The use of a single intravenous injection of metoprolol tartrate in the acute phase of MI against the background of high-dose atorvastatin for one month from the onset of MI is a highly effective pharmacological method for preventing the formation of early postinfarction myocardial remodeling.
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