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

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

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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 ± 12years). 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 30minutes 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 30minutes 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 <100mm 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.

Original languageEnglish
Pages (from-to)139-145
Number of pages7
JournalJournal of Cardiovascular Computed Tomography
Volume9
Issue number2
DOIs
Publication statusPublished - Jan 1 2015

Keywords

  • Beta-receptor blocker
  • Coronary CT angiography
  • Esmolol
  • Heart rate control
  • Metoprolol

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Maurovich-Horvat, P., Károlyi, M., Horváth, T., Szilveszter, B., Bartykowszki, A., Jermendy, Á. L., Panajotu, A., Celeng, C., Suhai, F. I., Major, G. P., Csobay-Novák, C., Hüttl, K., & Merkely, B. (2015). 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. Journal of Cardiovascular Computed Tomography, 9(2), 139-145. https://doi.org/10.1016/j.jcct.2015.02.001