Esmolol is noninferior to metoprolol in achieving a target heart rate of 65 beats/min in patients referred to coronary CT angiography: a randomized controlled clinical trial.

Abstract

BACKGROUND:

Coronary CT angiography (CTA) is an established tool to rule out coronary artery disease. Performance of coronary CTA is highly dependent on patients' heart rates (HRs). Despite widespread use of β-blockers for coronary CTA, few studies have compared various agents used to achieve adequate HR control.

OBJECTIVE:

We sought to assess if the ultrashort-acting β-blocker intravenous esmolol is at least as efficacious as the standard of care intravenous metoprolol for HR control during coronary CTA.

METHODS:

Patients referred to coronary CTA with a HR >65 beats/min despite oral metoprolol premedication were enrolled in the study. We studied 412 patients (211 male; mean age, 57 ± 12 years). Two hundred four patients received intravenous esmolol, and 208 received intravenous metoprolol with a stepwise bolus administration protocol. HR and blood pressure were recorded at arrival, before, during, immediately after, and 30 minutes after the coronary CTA scan.

RESULTS:

Mean HRs of the esmolol and metoprolol groups were similar at arrival (78 ± 13 beats/min vs 77 ± 12 beats/min; P = .65) and before scan (68 ± 7 beats/min vs 69 ± 7 beats/min; P = .60). However, HR during scan was lower in the esmolol group vs the metoprolol group (58 ± 6 beats/min vs 61 ± 7 beats/min; P < .0001), whereas HRs immediately and 30 minutes after the scan were higher in the esmolol group vs the metoprolol group (68 ± 7 beats/min vs 66 ± 7 beats/min; P = .01 and 65 ± 8 beats/min vs 63 ± 8 beats/min; P < .0001; respectively). HR ≤ 65 beats/min was reached in 182 of 204 patients (89%) who received intravenous esmolol vs 162 of 208 of the patients (78%) who received intravenous metoprolol (P < .05). Of note, hypotension (systolic BP <100 mm Hg) was observed right after the scan in 19 patients (9.3%) in the esmolol group and in 8 patients (3.8%) in the metoprolol group (P < .05), whereas only 5 patients (2.5%) had hypotension 30 minutes after the scan in the esmolol group compared to 8 patients (3.8%) in the metoprolol group (P = .418).

CONCLUSION:

Intravenous esmolol with a stepwise bolus administration protocol is at least as efficacious as the standard of care intravenous metoprolol for HR control in patients who undergo coronary CTA.

• Authors: Pál Maurovich-Horvat, Mihály Károlyi, Tamás Horváth, Bálint Szilveszter, Andrea Bartykowszki, Ádám L Jermendy, Alexisz Panajotu, Csilla Celeng, Ferenc I Suhai, Gyöngyi P Major, Csaba Csobay-Novák, Kálmán Hüttl, Béla Merkely
• Journal: Journal of cardiovascular computed tomography (J Cardiovasc Comput Tomogr) 2015 Mar-Apr Vol. 9 Issue 2 Pg. 139-45 ISSN: 1876-861X [Electronic] United States
• PMID: 25819196 (Publication Type: Clinical Trial, Phase III, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Propanolamines
• Metoprolol
• esmolol

Topics

• Aged
• Chi-Square Distribution
• Coronary Angiography (methods)
• Coronary Stenosis (diagnostic imaging)
• Female
• Heart Rate (drug effects, physiology)
• Humans
• Infusions, Intravenous
• Male
• Metoprolol (administration & dosage)
• Middle Aged
• Premedication (methods)
• Propanolamines (administration & dosage)
• Sensitivity and Specificity
• Tomography, X-Ray Computed (methods)