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Research Article | Open Access

Evaluation of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: a prospective multicenter single-arm interventional study

Xiao-Yun YIN12Yun-Mei ZHANG3Ai-Dong SHEN4Jing-Ping WANG5Zhe-Xun LIAN6Yi-Bing SHAO7Wen-Qi ZHANG8Shu-Ying ZHANG9Yang ZHENG10Kang CHENG11Biao XU12Cheng-Xing SHEN13Rong-Chong HUANG14Jin-Cheng GUO15Guo-Sheng FU16Dong-Kai SHAN1Dan-Dan LI1( )Yun-Dai CHEN1( )
Senior Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
Medical School of Chinese PLA, Beijing, China
Department of Cardiology, Yunnan First People’s Hospital, Kunming, China
Department of Heart Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, China
Department of Cardiology, the Affiliated Hospital of Qingdao University, Qingdao, China
Department of Cardiology, Qingdao Municipal Hospital, Qingdao, China
Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
Department of Cardiology, the Affiliated Zhongshan Hospital of Dalian University, Zhongshan, China
Cardiovascular Center, the First Hospital of Jilin University, Changchun, China
Department of Cardiology, the Affiliated Hospital of Northwest University & Xi’an No.3 Hospital, Xi’an, China
Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
Department of Cardiology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
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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 vs. -2.70 ± 9.47 beats/min, P = 0.034). There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2 (0 vs. 0, P = 1.000) and V4 (0.81% vs. 0.33%, P = 0.715). There was no significant difference in the proportion of hypotension between the two groups at V2 (0.004% vs. 0.004%, P = 1.000) and V4 (0 vs. 0.005%, P = 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.

References

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Journal of Geriatric Cardiology
Pages 256-267

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Cite this article:
YIN X-Y, ZHANG Y-M, SHEN A-D, et al. Evaluation of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: a prospective multicenter single-arm interventional study. Journal of Geriatric Cardiology, 2023, 20(4): 256-267. https://doi.org/10.26599/1671-5411.2023.04.001

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Published: 28 April 2023
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