Comparative Effectiveness of Metoprolol on Clinical Outcomes in Stemi Patients with Midline Versus Preserved Ejection Fraction: A Retrospective Cohort Study

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Background: The use of beta-blockers like metoprolol is essential in managing ST-elevation myocardial infarction (STEMI) by reducing myocardial oxygen demand and preventing adverse cardiovascular events.However, the effectiveness of metoprolol may vary depending on the patient's ejection fraction (EF), particularly between midline EF (41-49%) and preserved EF (≥50%).While previous studies indicate that lower EF may increase the risk of complications, the comparative outcomes between midline and preserved EF in beta-blocker therapy remain underexplored.This study addresses this gap by analysing the clinical outcomes of STEMI patients treated with metoprolol, focusing on differences between midline and preserved EF categories.Methods: A retrospective cohort study was conducted on 103 STEMI patients at Kumaran Medical Centre, Coimbatore, using data from cases diagnosed between 2019 and 2021, with a minimum follow-up period of three years.Patients were categorized into midline EF (n=52) and preserved EF groups (n=51).Outcomes of interest included reinfarction, stroke, heart failure, hypotension, and bradycardia.Statistical analyses were performed using Excel, employing chi-square tests to evaluate associations between EF categories and outcomes, and odds ratios (ORs) to assess the relative risk of adverse events in the midline EF group compared to the preserved EF group. Results:The study population predominantly consisted of older adults (≥56 years) and was largely male (76.7%), with an average age of 63.2 ± 7.4 years.Statistical analysis revealed significant differences in treatment outcomes for midline vs preserved EF groups, particularly for heart failure (P=0.03) and hypotension (P=0.04).ORs indicated increased risks of heart failure (OR=2.5),reinfarction (OR=1.6),stroke (OR=1.7),hypotension (OR=3.0),and bradycardia (OR=2.1) in midline EF patients compared to preserved EF patients. Conclusion:Patients with midline EF post-STEMI are at higher risk for adverse outcomes, especially heart failure and hypotension, when treated with metoprolol.These findings underscore the importance of tailored therapeutic strategies in managing STEMI patients based on EF category.

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