Stockholm Metoprolol Trial - SMT

Description:

SMT was a randomized, double-blind study of metoprolol versus placebo in post myocardial infarction patients for secondary prevention of thromboatherosclerotic events.

Hypothesis:

Metoprolol will be associated with reduced thromboatherosclerotic events compared with placebo in post-MI patients.

Study Design

Study Design:

Patients Enrolled: 301
Mean Follow Up: 3 years
Mean Patient Age: <70
Female: ~25

Patient Populations:

Men and women below the age of 70 in sinus rhythm without bundle branch block who survived the acute phase of myocardial infarction.

Exclusions:

None reported.

Primary Endpoints:

All cause mortality, sudden cardiac death, non-fatal reinfarction.

Secondary Endpoints:

Stroke

Drug/Procedures Used:

SMT randomized 301 patients 7 to 14 days post-MI to metoprolol 100 mg bid (n=154) or placebo (n=147). Patients were followed for 3 years.

Concomitant Medications:

All patients who had BP elevations >160/95 were treated with thiazide diuretics. If this was insufficient, hydralizine was added. Other reported medications included digitalis.

Principal Findings:

The trial enrolled 301 patients. At baseline the groups were well matched in terms of age, gender, and medical history.

All cause mortality at 3 years was lower in the metoprolol arm than placebo (21.1% vs. 16.2%, p=NS) but did not reach statistical significance. Cardiac deaths were also lower in the metoprolol arm but the difference did not reach statistical significance(19.7% vs. 13%, p=NS). Sudden death rates were significantly lower for beta blocker patients compared to placebo (21 deaths vs. 9, p<0.05). Non-fatal reinfarction rates were also lower for metoprolol patients (11.7% vs. 21.1%, p<0.05). The reduction in nonfatal reinfarction was similar in all pretreatment risk strata.

Interpretation:

Among post-MI patients, treatment with metoprolol was associated with significant reductions in sudden cardiac death and non-fatal reinfarction at three years compared with placebo. SMT is in agreement with many other post-MI beta blocker studies and has led to beta blockers as standard of care following myocardial infarction.

References:

Olsson G, Rehnqvist N, Sjogren A, Erhardy L, Lundman T, Long-term treatment with metoprolol after myocardial infarction: effect on 3 year mortality and morbidity. J Am Coll Cardiol 1985 Jun;5(6):1428-37

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias

Keywords: Myocardial Infarction, Heart Block, Standard of Care, Bundle-Branch Block, Metoprolol, Death, Sudden, Cardiac


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