On 2014 Jul 26, Borja Ibanez commented:

Fully agree with the comment. It is surprising that the infarct-limiting effect of b-blockers in the context of reperfused STEMI was not properly evaluated. The METOCARD-CNIC is the first trial and should be taken as a pilot endeavor. It shows that metoprolol (most probably not all b-blocker are equal in this regard) reduces infarct size. This was the primary endpoint and the trial was powered just for this outcome. All other benefits are hypothesis generating. Of note, the reduction in heart failure events could be of massive socioeconomic impact if proven in dedicated trials. There is a European multidisciplinary consortium working on the design of a large trial recruiting STEMI Pts in 8 countries randomizing them to pre-PCI metoprolol or placebo. primary outcome will be death or admission due to heart failure. This is the MOVE ON! trial. If positive, clinical practive will change. Until then, these results are the most promising in the field of cardioprotection in STEMI

On 2014 Jul 24, Ryan Radecki commented:

Post-publication commentary:

"The Return of Metoprolol – for Anterior STEMI"

Beta-blockade early in the course of myocardial infarction was once fashionable – until COMMIT demonstrated an excess of early cardiogenic shock detracting from subsequent late, favorable effects. This led to beta-blockade initiation being deferred until after hemodynamic stability established....

http://www.emlitofnote.com/2014/07/the-return-of-metoprolol-for-anterior.html

On 2014 Jul 24, Ryan Radecki commented:

Post-publication commentary:

"The Return of Metoprolol – for Anterior STEMI"

Beta-blockade early in the course of myocardial infarction was once fashionable – until COMMIT demonstrated an excess of early cardiogenic shock detracting from subsequent late, favorable effects. This led to beta-blockade initiation being deferred until after hemodynamic stability established....

http://www.emlitofnote.com/2014/07/the-return-of-metoprolol-for-anterior.html

On 2014 Jul 26, Borja Ibanez commented:

Fully agree with the comment. It is surprising that the infarct-limiting effect of b-blockers in the context of reperfused STEMI was not properly evaluated. The METOCARD-CNIC is the first trial and should be taken as a pilot endeavor. It shows that metoprolol (most probably not all b-blocker are equal in this regard) reduces infarct size. This was the primary endpoint and the trial was powered just for this outcome. All other benefits are hypothesis generating. Of note, the reduction in heart failure events could be of massive socioeconomic impact if proven in dedicated trials. There is a European multidisciplinary consortium working on the design of a large trial recruiting STEMI Pts in 8 countries randomizing them to pre-PCI metoprolol or placebo. primary outcome will be death or admission due to heart failure. This is the MOVE ON! trial. If positive, clinical practive will change. Until then, these results are the most promising in the field of cardioprotection in STEMI