Christopher Cannon, M.D. Brigham and Women’s Hospital Boston, MA. Perspective on COMMIT/CCS-2 Trial of Metoprolol in STEMI. First impression . Wow !? I had predicted dramatic benefit with multiple 0’s in the P value. Older B-blocker trials (up to 1986). >27,000 patients from 28 trials
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Brigham and Women’s Hospital
Boston, MAPerspective onCOMMIT/CCS-2 Trial of Metoprolol in STEMI
Current ACC/AHA guideline on the use of early -blocker in acute MI(ACC/AHA Task Force Report. J Am Coll Cardiol 2004;44:671-719
Current ESC Guideline for the use of early -blocker in acute MI(ESC Task Force Report. Euro Heart J 2003;24:28-66
……the use of iv -blockade in the acute phase of infarction in many countries is extremely low. There is a good case for the greater use of an iv -blocker when there is tachycardia (in the absence of heart failure), relative hypertension, or pain unresponsive to opioids. It may be prudent to test the patient’s response to this form of therapy by first using a short-acting preparation. In most patients, however, oral -blockade will suffice.