Early intravenous beta-blockers injection in patients with acute STEMI: the results of the Russian registry REGION-IM

Abstract

Aim. To study the features of the appointment of beta-blockers (BB) therapy in the early stages of acute myocardial infarction without ST segment elevation (nonSTEMI) in real clinical practice in the Russian Federation according to the REGION registry, to analyze the frequency and use cases of Intravenous forms (IVF).Material and methods. REGION-IM is a multicenter prospective Russian registry of acute myocardial infarction (AMI). The database records demographic, anamnestic, clinical characteristics of patients, results of laboratory and instrumental examinations. The patient’s recruitment was carried out from 01.11.2020 to 30.06.2023. Overall, 10,884 patients with AMI were included in the MI REGION, of which 3252 patients with non-STEMI and 7631 — with acute myocardial infarction with ST segment elevation (STEMI), information on the appointment or refusal of IV therapy on the first day of hospitalization is present for 7597 patients with STEMI.Results. On the first day after hospitalization, 1.2% (n=91) of patients with STEMI received IVF therapy. In all cases, metoprolol was used at an average daily dose of 4.43 mg. The majority of patients (61.5%, n=56) were transferred to oral administration of BB on the first day, another 33% of patients (n=30) — the next day, 4.4% (n=4) received only intravenous BB, one (1.1%) information is missing due to the transfer to another hospital. The most common relative and absolute contraindications to the appointment of BB — acute heart failure (AHF), including Killip II, and systolic blood pressure less than 120 mmHg. They were observed in less than 20% of all patients with STEMI and in 13% and 12% of patients who received IVF. 74% of patients received oral medications on the first day. Oral forms of BB were used to initiate therapy 61 times more often than IVF of BAB (p<0.0001). Hospital mortality among all patients with STEMI was 4.3% (n=328). Of these, 3.3% (n=249) — cardiac death, 0.7% (n=58) — non-cardiac cause of death, 0.3% (n=21) — the cause of death is not specified. In the group of patients who received IVF, 2.2% died (n=2, of which 1 was a cardiac cause, 1 was not indicated), 4.3% did not receive it (n=326, 76% was a cardiac cause). There was no statistically significant difference in hospital mortality in patients treated with IVF and those who did not receive IVF.Conclusion. The results of the REGION-IM registry demonstrate an unreasonably rare frequency of IVF use in the early stages of the disease in patients with STEMI. Intravenous administration of metoprolol at an average total dose of about 4-5 mg on the first day of hospitalization with further transition to oral administration of BAB was safe. There was no significant difference in the frequency of deaths in the hospital, cases of AHF, cardiogenic shock, severe conduction disorders in the form of grade II-III AV block between the groups of patients who received and did not receive IVF.