Stockholm Metoprolol Trial - SMT
SMT was a randomized, double-blind study of metoprolol versus placebo in post myocardial infarction patients for secondary prevention of thromboatherosclerotic events.
Metoprolol will be associated with reduced thromboatherosclerotic events compared with placebo in post-MI patients.
Patients Enrolled: 301
Mean Follow Up: 3 years
Mean Patient Age: <70
Men and women below the age of 70 in sinus rhythm without bundle branch block who survived the acute phase of myocardial infarction.
All cause mortality, sudden cardiac death, non-fatal reinfarction.
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.
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.
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.
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.
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
Keywords: Myocardial Infarction, Heart Block, Standard of Care, Bundle-Branch Block, Metoprolol, Death, Sudden, Cardiac
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