Letter by Argulian and Messerli Regarding Article, “Effect of Early Metoprolol on Infarct Size in ST-Segment–Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: The Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction (METOCARD-CNIC) Trial”
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To the Editor:
The conclusion of the trial by Ibanez et al1 elegantly documents that early intravenous β-blockade with intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events. These findings are in contrast to some extent with the guideline-changing Clopidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT), which examined the role of early β-blocker use in the emergency treatment of myocardial infarction.2 In this large trial, patients received an intravenous injection of 5 mg metoprolol, 2 to 3 …