• Vincent Roolvink, Saman Rasoul, Jan Paul Ottervanger, Jan-Henk E Dambrink, Erik Lipsic, Iwan C C van der Horst, Bart de Smet, Elvin Kedhi, A T Marcel Gosselink, Jan J Piek, Vicente Sanchez-Brunete, Borja Ibanez, Valentin Fuster, Arnoud W J Van't Hof, and EARLY-BAMI investigators.
• Isala Klinieken, Department of Cardiology, Zwolle, The Netherlands. Electronic address: v.r.c.derks@isala.nl.
• Am. Heart J. 2014 Nov 1;168(5):661-6.

Backgroundβ-Blockers have a class 1a recommendation in the treatment of patients with ST-elevation myocardial infarctions (STEMIs), as they are associated with a reduced mortality, recurrent myocardial infarction, life-threatening arrhythmias, and with prevention of unfavorable left ventricular remodeling. Whether early administration before primary percutaneous coronary intervention (PCI) of intravenous β-blockers reduces the infarct size in the current era is unknown.HypothesisWe postulate that the early administration of β-blockers will reduce the myocardial infarcted area as assessed by magnetic resonance imaging (MRI) at 30 days.DesignIn a multinational, multicenter, double-blind, placebo-controlled, randomized trial, patients with symptoms and signs of STEMI and transferred to a hospital for primary PCI will be randomized in a 1:1 fashion to intravenous metoprolol (5 mg twice daily) administration or placebo. Before admission, study treatment will be started as soon as possible after the diagnosis of STEMI. After admission, primary PCI will be performed as per standard of care. After primary PCI, medical treatment will occur as per current guidelines in all patients, including the use of oral β-blockers. The primary end point is the myocardial infarct size as assessed by MRI at 30 days. Based on a superiority design and assuming an 18% relative infarct size reduction (from 28% to 23.5%), 408 patients are required to be enrolled, accounting for 20% drop-out (α = .05 and power = 80%).SummaryThe EARLY-BAMI trial is a multinational, multicenter, double-blind, placebo-controlled, randomized clinical trial that will investigate the impact of intravenous metoprolol administration before primary PCI for STEMI on myocardial infarct size as measured with MRI at 30 days.Copyright © 2014 Elsevier Inc. All rights reserved.

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