Effect Of Using Enough Metoprolol Early On The Prognosis Of Patients With Acute Myocardial Infarction During Reperfusion Era:a Meta-analysis

Background and purpose:A number of previous clinical trials have suggested that early use of beta-blockers in early acute myocardial infarction can reduce early mortality,long-term use can reduce long-term mortality and re-infarction rate.Therefore,at home and abroad on the diagnosis and treatment of acute myocardial infarction are recommended,no contraindications should be given early in the disease ?-blockers;patients if tolerated,early can be given the maximum tolerance dose.However,some of the similar test results performed during the reperfusion period were not consistent with previous experimental results.Therefore,clinical practice for acute myocardial infarction should be sufficient early application of ?-blockers controversial.Previous research directions focused on the early use of ?-blockers and the relationship between the prognosis of acute myocardial infarction.However,due to the diversity of ?-blockers,the in vivo process,the mechanism of action and the clinical application value of different kinds of drugs are different.Therefore,the heterogeneity of these studies is different and the guidance of clinical practice is poor.At present,the clinical application of ?-blockers is dominated by metoprolol.Therefore,the aim of this study is to investigate the effects of metoprolol on acute myocardial infarction in the reperfusion era,and to further analyze them by meta-analysis The safety and efficacy of metoprolol in the early treatment of patients with acute myocardial infarction.Materials and methods:The meta-search was performed in the database by "metoprolol,metoprolol,?-blocker,myocardial infarction and reperfusion".(100-200 mg / d)in the early stage of acute myocardial infarction(within 24 hours of acute myocardial infarction),and clinical randomized controlled trials using metoprolol(test group)without the use or placebo(control group).The primary observation was the incidence of short-term mortality,long-term mortality,re-myocardial infarction,malignant ventricular arrhythmia,cardiogenic shock and atrioventricular block.Finally,Review Manager 5.3 was used for meta-analysis of the extracted data.Result: A total of 12 papers were selected and 48,507 patients were enrolled.(RR: 0.98,95% CI: 0.92-1.04,P = 0.44);the incidence of myocardial infarction was lower(RR: 0.79,P <0.05),and there was no significant difference in the short-term mortality rate between the experimental group and the control group(RR: 0.67,95% CI: 0.60-0.74,P <0.00001);the incidence of cardiogenic shock was increased(RR: 1.29,P <0.0001),and the incidence of cardiogenic shock was increased(RR: 0.67,95% CI: 0.70-0.89,P <0.0001)(RR: 1.01,95% CI: 0.88-1.17,P = 0.86).There was no significant difference in the incidence of atrioventricular block(RR: 1.01,95% CI: 0.88-1.17,P = 0.86).Conclusion:(1)in the reperfusion era,acute myocardial infarction in the early part of the application of metoprolol clear:(1)There is no sufficient evidence that the early use of metoprolol in the early stages of acute myocardial infarction has a significant benefit in terms of short-term mortality;(2)early application of metoprolol in the early stage of acute myocardial infarction can reduce the incidence of re-myocardial infarction;(3)early acute myocardial infarction in the early application of metoprolol can reduce the incidence of malignant ventricular arrhythmia.(2)in the reperfusion era,acute myocardial infarction early application of metoprolol in general relatively safe:(1)In the case of cardiogenic shock,early application of metoprolol to Killip class I,grade II patients does not increase the incidence of cardiogenic shock;but for Killip ? patients may increase the incidence of cardiogenic shock;(2)acute myocardial infarction early application of metoprolol does not increase the incidence of atrioventricular block.