Evaluation of Metoprolol Standard Dosing Pathway in Chinese Patients with Acute Coronary Syndrome: a Prospective Multicenter Single-arm Interventional Study

Overview

Journal J Geriatr Cardiol

Specialty Geriatrics

Date 2023 May 1

PMID 37122993

Authors

Xiao-Yun Yin

Yun-Mei Zhang

Ai-Dong Shen

Jing-Ping Wang

Zhe-Xun Lian

Yi-Bing Shao

Wen-Qi Zhang

Shu-Ying Zhang

Yang Zheng

Kang Cheng

Biao Xu

Cheng-Xing Shen

Rong-Chong Huang

Jin-Cheng Guo

Guo-Sheng Fu

Dong-Kai Shan

Dan-Dan Li

Yun-Dai Chen

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the feasibility and tolerability of metoprolol standard dosing pathway (MSDP) in Chinese patients with acute coronary syndrome (ACS).

Methods: In this multicenter, prospective, open label, single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals. A total of 998 hospitalized patients aged ≥ 18 years and diagnosed with ACS were included. The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines. The primary endpoint was the percentage of patients achieving the target dose at discharge (V2). The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge (V4), and percentage of patients experiencing bradycardia (heart rate < 50 beats/min), hypotension (blood pressure < 90/60 mmHg) and transient cardiac dysfunction at V2 and V4.

Results: Of the 998 patients, 29.46% of patients achieved the target dose (≥ 95 mg/d) at V2. The total population was divided into two groups: target group (patients achieving the target dose at V2) and non-target group (patients not achieving the target dose at V2). There was significant difference in the reduction of heart rate from baseline to discharge in the two groups (-4.97 ± 11.90 beats/min -2.70 ± 9.47 beats/min, = 0.034). There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2 (0 0, = 1.000) and V4 (0.81% 0.33%, = 0.715). There was no significant difference in the proportion of hypotension between the two groups at V2 (0.004% 0.004%, = 1.000) and V4 (0 0.005%, = 0.560). No transient cardiac dysfunction occurred in two groups during the study. A total of five adverse events (1.70%) and one serious adverse event (0.34%) were related to the pathway in target group.

Conclusions: In Chinese ACS patients, the feasibility and tolerability of the MSDP have been proved to be acceptable.

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