Copyright © 1985 by the European Society of Cardiology.
© 1985 The European Society of Cardiology
Metoprolol in acute myocardial infarction (MIAMI). A randomised placebo-controlled international trial
THE MIAMI TRIAL RESEARCH GROUPReceived 16 November 1984; revised 11 January 1985; .
Å Hjalmarson, MD (chairman), MIAMI Trial Steering Committee, Department of Medicine I, Sahlgren's Hospital, University of Göteborg, Göteborg, Sweden.
Abstract
The effect of metoprolol on mortality and morbidity after 15 days, was compared with that of placebo in a double-blind randomised international trial (the MIAMI trial) in patients with definite or suspected acute myocardial infarction (AMI). Treatment with intravenous metoprolol (15mg) or placebo was started shortly after the patient's arrival in hospital within 24 h of the onset of symptoms, and then oral treatment (200 mg daily) was continued for the study period (15 days). Of the 5778 patients included, 2901 were allocated to placebo and 2877 to metoprolol. Definite AMI was confirmed in 4127 patients. There were 142 deaths in the placebo group (4.9%) and 123 deaths in the metoprolol group (4.3%), a difference of 13 per cent with 95 per cent confidence limits of –8 to +33 per cent, not statistically significant (P=0.29).
Previously recorded risk indicators of mortality were analysed in retrospect. These indicated that there was a category which showed higher risk which contained approximately 30% of all randomized patients. In these, the mortality rate in the metoprolol treated group was 29% less than in the placebo group. In the remaining lower risk categories there was no difference between the treatment groups. This subset analysis must be interpreted with caution in view of the findings from other similar studies.
Positive effects were observed on the incidence of definite AMI and on serum enzyme activity in patients treated early ( <7h). There was no significant effect on ventricular fibrillation but the number of episodes tended to be lower in the metoprolol treated patients during the later phase (6–15 days; 24 vs 54 episodes). The incidence of supraventricular tachyarrhythmias, the use of cardiac glycosides and other antiarrhythmics, and the need for pain-relieving treatment were significantly diminished by metoprolol amongst all randomised patients. Adverse events associated with metoprolol were infrequent, expected, and relatively mild.
Key Words: Acute myocardial infarction • metoprolol • beta-blockade • mortality
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  B. J. Holycross, M. Kukielka, Y. Nishijima, R. A. Altschuld, C. A. Carnes, and G. E. Billman Exercise training normalizes beta-adrenoceptor expression in dogs susceptible to ventricular fibrillation Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H2702 - H2709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Schwartz and E. Vanoli From exercise training to sudden death prevention via adrenergic receptors Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H2631 - H2633. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Bangalore, F. H. Messerli, J. B. Kostis, and C. J. Pepine Cardiovascular Protection Using Beta-Blockers: A Critical Review of the Evidence J. Am. Coll. Cardiol., August 14, 2007; 50(7): 563 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF]
|
|
|
|
 |
|
 E. R. Bates Role of Intravenous -Blockers in the Treatment of ST-Elevation Myocardial Infarction: Of Mice (Dogs, Pigs) and Men Circulation, June 12, 2007; 115(23): 2904 - 2906. [Full Text] [PDF]
|
|
|
|
|
|
B. Ibanez, S. Prat-Gonzalez, W. S. Speidl, G. Vilahur, A. Pinero, G. Cimmino, M. J. Garcia, V. Fuster, J. Sanz, and J. J. Badimon Early Metoprolol Administration Before Coronary Reperfusion Results in Increased Myocardial Salvage: Analysis of Ischemic Myocardium at Risk Using Cardiac Magnetic Resonance Circulation, June 12, 2007; 115(23): 2909 - 2916. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. P. Alexander, L. K. Newby, P. W. Armstrong, C. P. Cannon, W. B. Gibler, M. W. Rich, F. Van de Werf, H. D. White, W. D. Weaver, M. D. Naylor, et al. Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology Circulation, May 15, 2007; 115(19): 2570 - 2589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Takahashi, T. Tang, N. C. Lai, D. M. Roth, B. Rebolledo, M. Saito, W. Y.W. Lew, P. Clopton, and H. K. Hammond Increased Cardiac Adenylyl Cyclase Expression Is Associated With Increased Survival After Myocardial Infarction Circulation, August 1, 2006; 114(5): 388 - 396. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. E. Billman, M. Kukielka, R. Kelley, M. Moustafa-Bayoumi, and R. A. Altschuld Endurance exercise training attenuates cardiac beta2-adrenoceptor responsiveness and prevents ventricular fibrillation in animals susceptible to sudden death Am J Physiol Heart Circ Physiol, June 1, 2006; 290(6): H2590 - H2599. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Atar, M. E. Korkmaz, I. A. Atar, O. Gulmez, B. Ozin, H. Bozbas, T. Erol, A. Aydinalp, A. Yildirir, M. Yucel, et al. Effects of metoprolol therapy on cardiac troponin-I levels after elective percutaneous coronary interventions Eur. Heart J., March 1, 2006; 27(5): 547 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. B. Mrdovic Is the level of evidence for the use of beta-blockers in acute myocardial infarction satisfactory enough? Eur. Heart J., January 1, 2006; 27(1): 118 - 119. [Full Text] [PDF]
|
|
|
|
|
|
Part 8: Stabilization of the Patient With Acute Coronary Syndromes Circulation, December 13, 2005; 112(24_suppl): IV-89 - IV-110. [Full Text] [PDF]
|
|
|
|
 |
|
 C. G. McDonald, S. R. Majumdar, J. L. Mahon, and J. A. Johnson The Effectiveness of {beta}-Blockers After Myocardial Infarction in Patients With Type 2 Diabetes Diabetes Care, September 1, 2005; 28(9): 2113 - 2117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Kloner and S. H. Rezkalla Cardiac protection during acute myocardial infarction: Where do we stand in 2004? J. Am. Coll. Cardiol., July 21, 2004; 44(2): 276 - 286. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Mehta, K. J. Harjai, L. Grines, G. W. Stone, J. Boura, D. Cox, W. O'Neill, C. L. Grines, and Primary Angioplasty in Myocardial Infarction (PAMI Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention: Incidence, predictors, and outcomes J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1765 - 1772. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J Everly, P. C Heaton, and R. J Cluxton Jr {beta}-Blocker Underuse in Secondary Prevention of Myocardial Infarction Ann. Pharmacother., February 1, 2004; 38(2): 286 - 293. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Silvet, F. Spencer, J. Yarzebski, D. Lessard, J. M. Gore, and R. J. Goldberg Communitywide Trends in the Use and Outcomes Associated With {beta}-Blockers in Patients With Acute Myocardial Infarction: The Worcester Heart Attack Study Arch Intern Med, October 13, 2003; 163(18): 2175 - 2183. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Torp-Pedersen, C. Rask-Madsen, I. Gustafsson, F. Gustafsson, and L. Kober Diabetes mellitus and cardiovascular risk: just another risk factor? Eur. Heart J. Suppl., August 1, 2003; 5(suppl_F): F26 - F32. [Abstract] [PDF]
|
|
|
|
|
|
A. K. Berger, S. Duval, and H. M. Krumholz Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction J. Am. Coll. Cardiol., July 16, 2003; 42(2): 201 - 208. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Armanious, D. T. Wong, E. Etchells, P. Higgins, and F. Chung Successful implementation of perioperative beta-blockade utilizing a multidisciplinary approach: [L'application reussie d'un beta-blocage perioperatoire par une approche multidisciplinaire] Can J Anesth, February 1, 2003; 50(2): 131 - 136. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Laakso and J. Kuusisto Diabetology for cardiologists Eur. Heart J. Suppl., January 1, 2003; 5(suppl_B): B5 - B13. [Abstract] [PDF]
|
|
|
|
|
|
M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840. [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Wright, G. S. Reeder, C. A. Herzog, R. C. Albright, B. A. Williams, D. L. Dvorak, W. L. Miller, J. G. Murphy, S. L. Kopecky, and A. S. Jaffe Acute Myocardial Infarction and Renal Dysfunction: A High-Risk Combination Ann Intern Med, October 1, 2002; 137(7): 563 - 570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Chan, M. J. Quinn, D. L. Bhatt, D. P. Chew, D. J. Moliterno, E. J. Topol, and S. G. Ellis Mortality benefit of beta-blockade after successful elective percutaneous coronary intervention J. Am. Coll. Cardiol., August 21, 2002; 40(4): 669 - 675. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. E. Billman Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention J Appl Physiol, February 1, 2002; 92(2): 446 - 454. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. N. Singh CIBIS, MERIT-HF, and COPERNICUS Trial Outcomes: Do They Complete the Chapter on -Adrenergic Blockers as Antiarrhythmic and Antifibrillatory Drugs? Journal of Cardiovascular Pharmacology and Therapeutics, June 1, 2001; 6(2): 107 - 110. [PDF]
|
|
|
|
|
|
M.E Bertrand, M.L Simoons, K.A.A Fox, L.C Wallentin, C.W Hamm, E McFadden, P.J de Feyter, G Specchia, and W Ruzyllo Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology: Recommendations of the Task Force of the European Society of Cardiology Eur. Heart J., September 1, 2000; 21(17): 1406 - 1432. [PDF]
|
|
|
|
|
|
G.Y.H. Lip, C. Lydakis, and D.G. Beevers Management of patients with myocardial infarction and hypertension Eur. Heart J., July 2, 2000; 21(14): 1125 - 1134. [PDF]
|
|
|
|
|
|
S Gottlieb, U Goldbourt, V Boyko, D Harpaz, L Mandelzweig, Z Khoury, S Stern, S Behar, and for the SPRINT and Israeli Thrombolytic Survey Gro Mortality trends in men and women with acute myocardial infarction in coronary care units in Israel. A comparison between 1981-1983 and 1992-1994 Eur. Heart J., February 2, 2000; 21(4): 284 - 295. [Abstract] [PDF]
|
|
|
|
|
|
B. N. Singh Initial Antiarrhythmic Drug Therapy During Resuscitation from Sudden Cardiac Death: A Time for a Fundamental Change in Strategy? Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 2000; 5(1): 3 - 9. [PDF]
|
|
|
|
|
|
S. Doshi and B. N. Singh Reducing Perioperative Cardiac Risk in Noncardiac Surgery: A Time to Delineate Simpler Strategies? Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 2000; 5(2): 69 - 75. [PDF]
|
|
|
|
|
|
S. B. Soumerai, T. J. McLaughlin, J. H. Gurwitz, S. Pearson, C. L. Christiansen, C. Borbas, N. Morris, B. McLaughlin, X. Gao, and D. Ross-Degnan Timeliness and Quality of Care for Elderly Patients With Acute Myocardial Infarction Under Health Maintenance Organization vs Fee-for-Service Insurance Arch Intern Med, September 27, 1999; 159(17): 2013 - 2020. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K S Spargias, A S Hall, D C Greenwood, and S G Ball beta Blocker treatment and other prognostic variables in patients with clinical evidence of heart failure after acute myocardial infarction: evidence from the AIRE study Heart, January 1, 1999; 81(1): 25 - 32. [Abstract] [Full Text]
|
|
|
|
|
|
D. J. Willison, S. B. Soumerai, T. J. McLaughlin, J. H. Gurwitz, X. Gao, E. Guadagnoli, S. Pearson, P. Hauptman, and B. McLaughlin Consultation Between Cardiologists and Generalists in the Management of Acute Myocardial Infarction: Implications for Quality of Care Arch Intern Med, September 14, 1998; 158(16): 1778 - 1783. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. McCullough, W. W. O'Neill, M. Graham, R. J. Stomel, F. Rogers, S. David, A. Farhat, R. Kazlauskaite, M. Al-Zagoum, and C. L. Grines A prospective randomized trial of triage angiography in acute coronary syndromes ineligible for thrombolytic therapy: Results of the medicine versus angiography in thrombolytic exclusion (MATE) trial J. Am. Coll. Cardiol., September 1, 1998; 32(3): 596 - 605. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H Mehta and K. A Eagle Fortnightly review: Secondary prevention in acute myocardial infarction BMJ, March 14, 1998; 316(7134): 838 - 842. [Full Text]
|
|
|
|
|
|
G. E. Billman, L. C. Castillo, J. Hensley, C. M. Hohl, and R. A. Altschuld ß2-Adrenergic Receptor Antagonists Protect Against Ventricular Fibrillation : In Vivo and In Vitro Evidence for Enhanced Sensitivity to ß2-Adrenergic Stimulation in Animals Susceptible to Sudden Death Circulation, September 16, 1997; 96(6): 1914 - 1922. [Abstract] [Full Text]
|
|
|
|
|
|
S. Basu, R. Senior, U. Raval, R. van der Does, T. Bruckner, and A. Lahiri Beneficial Effects of Intravenous and Oral Carvedilol Treatment in Acute Myocardial Infarction : A Placebo-Controlled, Randomized Trial Circulation, July 1, 1997; 96(1): 183 - 191. [Abstract] [Full Text]
|
|
|
|
 |
|
 C. H. Hennekens, C. M. Albert, S. L. Godfried, J. M. Gaziano, and J. E. Buring Adjunctive Drug Therapy of Acute Myocardial Infarction -- Evidence from Clinical Trials N. Engl. J. Med., November 28, 1996; 335(22): 1660 - 1668. [Full Text] [PDF]
|
|
|
|
|
|
G. Neumayr, J. Ganzer, L. Kober, C. Torp-Pedersen, and J. Carlsen Trandolapril in Patients with Left Ventricular Dysfunction after Myocardial Infarction N. Engl. J. Med., June 6, 1996; 334(23): 1546 - 1546. [Full Text]
|
|
|
|
 |
|
 T. J. Cleophas, M. van't Leven, F. H. Kauw, H. P. Remmert, A. Kuijper, K. Zwinderman, and D. Math Celiprolol vs Propranolol in Unstable Angina Pectoris: A Double-Blind, Randomized, Parallel-Group Study Angiology, February 1, 1995; 46(2): 137 - 144. [Abstract] [PDF]
|
|