Acute myocardial infarction (AMI) is the main cause of death in western countries. The best strategy to limit myocardial damage is to perform an early coronary reperfusion; however, reperfusion itself comes at the price of additional myocardial damage, known as ischemia/reperfusion injury (I/R).
The duration of ischemia can only be shortened through coordinated healthcare policies aimed at early detection and transfer of patients to hospitals with angioplasty capabilities. I/R injury, on the other hand, could potentially be reduced by pharmacological approaches; but despite great efforts, no therapy has been shown to consistently limit this phenomenon.
β-blockers are a class of drugs that have been used to treat cardiovascular conditions for several decades. β-blockers reduce mortality when administered after an AMI, and are a class IA indication in this context. What remains unclear is what timing and route of β-blocker administration gives the maximum cardioprotective effect. In particular, whether early β-blocker administration is able to reduce infarct size is a subject of debate. Experimental data from our laboratory suggest that the β1 selective blocker metoprolol is able to limit the area of necrosis only when administered before reperfusion.
METOCARD-CNIC is a multicenter randomized clinical trial comparing the effect of early and delayed metoprolol initiation on infarct size and clinical events in more than 200 patients with AMI.
Patients are currently being recruited in cities across Spain in close collaboration with emergency medical services and hospitals. The main endpoints of this trial will be evaluated by innovative magnetic resonance imaging protocols developed at the CNIC Imaging Facility.