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| 2. |
- Berggren, H, et al.
(författare)
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Myocardial Protective Effect of Maintained Beta-Blockade in Aorto-Coronary Bypass Surgery
- 1983
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa Healthcare. - 1401-7431 .- 1651-2006. ; 17:1, s. 29-32
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Tidskriftsartikel (refereegranskat)abstract
- Twenty-nine patients were randomly allocated to two groups before undergoing aorto-coronary bypass surgery. In one group the beta-blocking medication was withdrawn three days preoperatively, and in the other group it was maintained. The patients in the latter group were additionally given 100 mg metoprolol per os two hours before surgery. The degree of myocardial injury, as judged from cumulated activity of S-CK B, was less when the beta-blockade was maintained.
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| 3. |
- Herlitz, Johan, et al.
(författare)
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Correlation between electrocardiographically and enzymatically estimated infarct size and its relation to clinical course in inferior myocardial infarction
- 1984
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Ingår i: Acta Cardiologica. - : La Societe Belge de Cardiologie. - 0001-5385 .- 1784-973X. ; 39:6, s. 437-448
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Tidskriftsartikel (refereegranskat)abstract
- In 194 patients with inferior wall acute myocardial infarction (MI) defined from ECG, the initial ST elevation and final Q- and R-wave changes in leads II, III and aVF were related to peak serum enzyme (heat stable lactate dehydrogenase) activity. Positive correlations were observed between initial ST elevation and peak LD (r = 0.54; p less than 0.001) and between peak LD and the final Q- and R-wave changes (r = 0.45; p less than 0.001). Peak LD activity was strongly related to the incidence and severity of congestive heart failure, and to mortality after 90 days and 2 years. A similar relationship could not be demonstrated between ECG findings and clinical outcome.
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| 4. |
- Herlitz, Johan, et al.
(författare)
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Correlation between enzymatic estimation of infarct size and early mortality rate.
- 1983
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Ingår i: British Heart Journal. - : BMJ Group. - 0007-0769. ; 50:6, s. 520-524
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Tidskriftsartikel (refereegranskat)abstract
- In 585 patients with a first acute myocardial infarction the maximum activity of heat stable lactate dehydrogenase (EC 1.1.1.27) was correlated with mortality at three months. The patients participated in a double blind trial with metoprolol in acute myocardial infarction. In all patients not taking a beta blocker a highly significant correlation was found, but this was not evident in those who were. When patients with anterior or inferior infarctions treated with a placebo were analysed separately the correlation remained, as it did when the patients who were alive on the fourth day after the onset of pain were analysed separately. No correlation was observed between enzyme activity and three month mortality in these subgroups if only patients treated with metoprolol were included. In a subsample of only 171 patients it was found that the maximum activity of creatine kinase (EC 2.7.3.2) and creatine kinase subunit B did not correlate with three month mortality regardless of treatment. Thus it is concluded that when a sufficiently large number of patients are investigated there is a highly significant correlation between the enzymatic estimation of infarct size and early mortality in acute myocardial infarction. This relation did not persist when patients treated with beta blockade were analysed.
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| 5. |
- Herlitz, Johan, et al.
(författare)
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Effect of metoprolol on indirect signs of the size and severity of acute myocardial infarction
- 1983
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Ingår i: American Journal of Cardiology. - : Elsevier Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 51:8, s. 1282-1288
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Tidskriftsartikel (refereegranskat)abstract
- In a double-blind randomized trial, 1,395 patients with suspected acute myocardial infarction (MI) were investigated to evaluate the possibility of limiting indirect signs of the size and severity of acute MI with the beta1-selective adrenoceptor antagonist metoprolol. Metoprolol (15 mg) was given intravenously and followed by oral administration for 3 months (200 mg daily). Placebo was given in the same way. The size of the MI was estimated by heat-stable lactate dehydrogenase (LD[EC 1.1.1.27]) analyses and precordial electrocardiographic mapping. Lower maximal enzyme activities compared with placebo were seen in the metoprolol group (11.1 ± 0.5 μkat · liter−1)when the patient was treated within 12 hours of the onset of pain (13.3 ± 0.6 μkat · liter−1; n = 936; p = 0.009). When treatment was started later than 12 hours, no difference was found between the 2 groups. Enzyme analyses were performed in all but 20 patients (n = 1,375). Precordial mapping with 24 chest electrodes was performed in patients with anterior wall MI. The final total R-wave amplitude was higher and the final total Q-wave amplitude lower in the metoprolol group than in the placebo group. Patients treated with metoprolol ≤12 hours also showed a decreased need for furosemide, a shortened hospital stay, and a significantly reduced 1-year mortality compared with the placebo group, whereas no difference was observed among patients treated later on. After 3 months, however, there was a similar reduction in mortality among patients in whom therapy was started 12 hours and >12 hours after the onset of pain. The results support the hypothesis that intravenous metoprolol followed by oral treatment early in the course of suspected myocardial infarction can limit infarct size and improve longterm prognosis.
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| 6. |
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| 7. |
- Herlitz, Johan, et al.
(författare)
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Enzymatically and electrocardiographically estimated infarct size in relation to pain in acute myocardial infarction
- 1984
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 71:5, s. 239-246
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Tidskriftsartikel (refereegranskat)abstract
- In 563 patients with acute myocardial infarction and no previous myocardial infarction, the estimated infarct size was related to the estimated duration of pain and the amount of analgesics given. The size of infarction estimated from analyses of heat-stable lactate dehydrogenase (EC 1.1.1.27) at 12-hour intervals for 48-108 h and from Q- and R-wave changes in the ECG correlated positively, although weakly with duration of the pain and the amount of analgesics given. These data support the hypothesis that larger infarcts, as a group, evolve over a longer time period than smaller infarcts and that the duration of pain in many patients might be an indicator of the infarct size. In the individual patient, however, one cannot predict the size of the infarction from the severity of pain.
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| 8. |
- Herlitz, Johan, et al.
(författare)
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Göteborg Metoprolol Trial : mortality and causes of death
- 1984
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Ingår i: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 53:13, s. 9-14
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Tidskriftsartikel (refereegranskat)abstract
- During the 3-month blind treatment period there were 40 deaths in the metoprolol group compared with 62 deaths in the placebo group (p = 0.024). During the first year (after 3 months the 2 groups were treated similarly) there were 64 deaths in the metoprolol group vs 93 in the placebo group (p = 0.017) and during 2 years 92 patients died in the metoprolol group vs 120 in the placebo group (p = 0.043). The relative incidence of different causes of death did not differ significantly between the 2 treatment groups, indicating that metoprolol reduced all causes of death to the same extent as its effect on overall mortality.
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| 9. |
- Herlitz, Johan, et al.
(författare)
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Göteborg Metoprolol Trial : enzyme-estimated infarct size
- 1984
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Ingår i: American Journal of Cardiology. - : Elsevier. - 0002-9149 .- 1879-1913. ; 53:13, s. 15-21
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Tidskriftsartikel (refereegranskat)abstract
- In 1,375 patients serum activity of heat-stable lactate dehydrogenase (LD; E.C.1.1.1.27.) was analyzed every twelfth hour for 48 to 108 hours. The mean maximum LD activity was 11.1 +/- 0.4 mu kat X 1(-1) in the metoprolol group vs 12.4 +/- 0.5 mu kat X 1(-1) in the placebo group (p = 0.054). In patients in whom treatment was started 12 hours or less after the onset of pain, a 17% reduction in LD activity was observed (p = 0.009) and similar results were found in patients randomized 8 hours or less. Groups in which the effect after metoprolol treatment was more pronounced were those with an initially higher heart rate and also those with anterior myocardial infarction.
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| 10. |
- Herlitz, Johan, et al.
(författare)
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Göteborg Metoprolol Trial : design, patient characteristics and conduct
- 1984
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Ingår i: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 53:13, s. 3D-8D
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Tidskriftsartikel (refereegranskat)abstract
- The Göteborg Metoprolol Trial was a double-blind, placebo-controlled, stratified trial aimed at evaluating the effect of the beta 1-selective blocker, metoprolol, in suspected acute myocardial infarction and during 2 years of follow-up. The primary end-point was 3-month mortality (blind treatment period). Secondary end-points were 2-year mortality, indirect signs of infarct size, chest pain, arrhythmias and tolerability. The entry criteria were fulfilled in 2,802 patients, 1,395 of whom were included in the trial. Treatment started as soon as possible after arrival in hospital with intravenous administration followed by oral treatment for 3 months. All patients were randomized 48 hours or less after estimated onset of infarction and 69% were randomized at 12 hours or less. The blind treatment had to be withdrawn in 19% of all randomized patients before the end of the 3-month follow-up.
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