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October 6, 1993, Vol 270, No. 13 >
ARTICLE | October 6, 1993

Effects of Prophylactic Antiarrhythmic Drug Therapy in Acute Myocardial Infarction: Title and subTitle BreakAn Overview of Results From Randomized Controlled Trials FREE

Koon K. Teo, MBBCh, PhD, FRCPC; Salim Yusuf, MBBS, FRCP, DPhil; Curt D. Furberg, MD, PhD
[+] Author Affiliations

Reprint requests to the Division of Cardiology, University of Alberta, 2C2 Walter Mackenzie Centre, Edmonton, Alberta, Canada T6G 2R7 (Dr Teo).


JAMA. 1993;270(13):1589-1595. doi:10.1001/jama.1993.03510130095038
Text Size: A A A
Published online
Article
References

Objective.  —To investigate the effects of prophylactic therapy with antiarrhythmic agents on mortality in patients with myocardial infarction.

Data Sources and Study Selection.  —Data were obtained from all completed, published or unpublished, randomized, parallel controlled trials of antiarrhythmic agents, regardless of sample size. Investigators were contacted for data on patients excluded after randomization.

Data Extraction.  —Data on mortality were extracted by one author and confirmed where necessary by the others.

Data Synthesis.  —Mortality data from 138 trials on 98 000 patients were combined by the Yusuf-Peto adaptation of the Mantel-Haenszel method. There were 660 deaths among 11 712 patients allocated to receive class I agents and 571 deaths among 11 517 corresponding control patients (51 trials: odds ratio [OR], 1.14;95% confidence interval [Cl], 1.01 to 1.28; P=03). Of 26 973 patients allocated to receive β-blockers (class II agents), 1464 died compared with 1727 deaths among 26 295 control patients (55 trials: OR, 0.81; 95% CI, 0.75 to 0.87; P=.00001). Of 778 patients allocated to receive amiodarone (a class III agent), 77 died compared with 101 deaths in 779 control patients (eight trials: OR, 0.71; 95% Cl, 0.51 to 0.97; P=.03). There were 982 deaths in 10 154 patients allocated to receive a class IV agent (calcium channel blockers) and 949 deaths in 10 188 control patients (24 trials: OR, 1.04; 95% CI, 0.95 to 1.14; P=.41).

Conclusions.  —The routine use of class I antiarrhythmic agents after myocardial infarction is associated with increased mortality. β-Blockers have been conclusively demonstrated to reduce mortality. The limited data on amiodarone appear promising. Data on calcium channel blockers remain unpromising.(JAMA. 1993;270:1589-1595)

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
May GS, Furberg CD, Eberlein KA, Geraci BJ.  Secondary prevention after myocardial infarction: a review of short-term acute phase trials. Prog Cardiovasc Dis . 1983;;25:335-359.
2 +
Bigger JT Jr, Dresdale FJ, Heissenbuttel RH, Weld FM, Wit AL.  Ventricular arrhythmias in ischemic heart disease: mechanism, prevalence, significance, and management. Prog Cardiovasc Dis . 1977;;19:255-300.
3 +
May GS, Eberlein KA, Furberg CD, Passamani ER, DeMets DL.  Secondary prevention after myocardial infarction: a review of long-term trials. Prog Cardiovasc Dis . 1982;;24:331-352.
4 +
Weinblatt E, Shapiro S, Frank CW, Sager RV.  Prognosis of men after first myocardial infarction: mortality and first recurrence in relation to selected parameters. Am J Public Health . 1968;;58: 1329-1347.
5 +
The Multicenter Postinfarction Research Group.  Risk stratification and survival after myocardial infarction. N Engl J Med . 1983;;309:331-336.
6 +
Moss AJ, DeCamilla JJ, Davis HP, Bayer L.  Clinical significance of ventricular ectopic beats in the early posthospital phase of myocardial infarction. Am J Cardiol . 1977;;39:635-640.
7 +
Schaffer WA, Cobb LA.  Recurrent ventricular fibrillation and modes of death in survivors of out-of-hospital ventricular fibrillation. N Engl J Med . 1975;;293:259-262.
8 +
Jones DT, Kostuk WJ, Gunton RW.  Prophylactic quinidine for the prevention of arrhythmias after acute myocardial infarction. Am J Cardiol . 1974;; 33:655-660.
9 +
Holmberg S, Bergman H.  Prophylactic quinidine treatment in myocardial infarction: a double blind study. Acta Med Scand . 1967;;181:297-304.
10 +
Koch-Weser J, Klein SW, Foo-Canto LL, Kastor JA, DeSanctis RW.  Antiarrhythmic prophylaxis with procainamide in acute myocardial infarction. N Engl J Med . 1969;;281:1253-1260.
11 +
Campbell RWF, Talbot RG, Dolder MA, Murray A, Prescott LF, Julian DG.  Comparison of procainamide and mexiletine in prevention of ventricular arrhythmias after acute myocardial infaretion. Lancet . 1975;;1:1257-1260.
12 +
Reynell PC.  Prophylactic procaine amide in myocardial infarction. Br Heart J . 1961;;23:421-424.
13 +
Nielsen BL, Clausen J, Nielsen JS.  Can procainamide improve the prognosis of patients with ventricular arrhythmias after myocardial infarction? Dan Med Bull . 1978;;25:121-125.
14 +
Kosowsky BD, Taylor J, Lown B, Ritchie RF.  Long-term use of procaine amide following acute myocardial infarction. Circulation . 1973;;47:1204-1210.
15 +
Allen-Narker RAC, Roberts CJC, Marshall AJ, Jordan SC, Barritt W, Goodfellow RM.  Prophylaxis against ventricular arrhythmias in suspected acute myocardial infarction: a comparison of tocainide and disopyramide. Br J Clin Pharmacol . 1984;;18:725-732.
16 +
Jennings G, Model DG, Jones MBS, Turner PP, Besterman EMM, Kidner PH.  Oral disopyramide in prophylaxis of arrhythmias following myocardial infarction. Lancet . 1976;;1:51-54.
17 +
Zainal N, Carmichael DJS, Griffith JW, et al.  Oral disopyramide for the prevention of arrhythmias in patients with acute myocardial infarction admitted to open wards. Lancet . 1977;;2:887-889.
18 +
Nicholls DP, Haybyrne T, Barnes PC.  Intravenous and oral disopyramide after myocardial infarction. Lancet . 1980;;2:936-938.
19 +
UK Rythmodan Multicentre Study Group.  Oral disopyramide after admission to hospital with suspected acute myocardial infarction. Postgrad Med J . 1984;;60:98-107.
20 +
Pouleur H, Chaudron JM, Reyns P.  Effects of disopyramide and aprindine on arrhythmias after acute myocardial infarction. Eur J Cardiol . 1977;; 5:397-404.
21 +
Wilcox RG, Rowley JM, Hampton JR, Mitchell JRA, Roland JM, Banks DC.  Randomized placebocontrolled trial comparing oxprenolol with disopyramide phosphate in immediate treatment of suspected myocardial infarction. Lancet . 1980;;2:765-769.
22 +
The Cardiac Arrhythmia Pilot Study (CAPS) Investigators.  Effects of encainide, flecainide, imipramine and moricizine on ventricular arrhythmias during the year after acute myocardial infarction: the CAPS. Am J Cardiol . 1988;;61:501-509.
23 +
The Cardiac Arrhythmia Suppression Trial II Investigators.  Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med . 1992;;327:227-233.
24 +
Kostuk WJ, Beanlands DS.  Prophylactic lidocaine in acute myocardial infarction. Circulation . 1969;;39( (suppl) ):111-125.
25 +
Bennett MA, Wilner JM, Pentecost BL.  Controlled trial of lignocaine in prophylaxis of ventricular arrhythmias complicating myocardial infarction. Lancet . 1970;;2:909-911.
26 +
Baker IA, Collins JV, Evans TR.  Prophylaxis of ventricular dysrrhythmias following acute myocardial infarction: a double-blind trial of continuous intravenous infusion of lignocaine. Guys Hosp Rep . 1971;;120:1-7.
27 +
Chopra MP, Thadani U, Portal RW, Aber CP.  Lignocaine therapy for ventricular ectopic activity after acute myocardial infarction: a double-blind trial. BMJ . 1971;;2:668-670.
28 +
Pitt A, Lipp H, Anderson ST.  Lignocaine given prophylactically to patients with acute myocardial infarction. Lancet . 1971;;1:612-616.
29 +
Darby S, Bennett MA, Cruickshank JC, Pentecost BL.  Trial of combined intramuscular and intravenous lignocaine in prophylaxis of ventricular tachyarrhythmias. Lancet . 1972;;1:817-819.
30 +
O'Brien KP, Taylor PM, Croxson RS.  Prophylactic lidocaine in hospital patients with acute myocardial infarction. Med J Aust . 1973;;2( (suppl) ):36-37.
31 +
Lie KI, Wellens HJ, Van Capelle FJ, Durrer D.  Lidocaine in the prevention of primary ventricular fibrillation: a double-blind, randomized study of 212 consecutive patients. N Engl J Med . 1974;;291:1324-1326.
32 +
Wyse DG, Kellen J, Rademaker AW.  Prophylactic versus selective lidocaine for early ventricular arrhythmias of myocardial infarction. J Am Coll Cardiol . 1988;;12:507-513.
33 +
Hargarten KM, Aprahamian CA, Stueven HA, Thompson BM, Mateer JR, Darin J.  Prophylactic lidocaine in the prehospital patient with chest pain of suspected cardiac origin. Ann Emerg Med . 1986;; 15:881-885.
34 +
Sandler G, Dey N, Amonkar J.  Prophylactic intramuscular lidocaine in myocardial infarction. Curr Ther Res . 1976;;20:563-573.
35 +
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36 +
Lie KI, Liem KI, Louridtz WJ, Janse MJ, Willebrands AF, Durrer D.  Efficacy of lidocaine in preventing primary ventricular fibrillation within 1 hour after a 300 mg intramuscular injection: a doubleblind, randomized study of 300 hospitalized patients with acute myocardial infarction. Am J Cardiol . 1978;;42:486-488.
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Dunn HM, McComb JM, Kinney CD, et al.  Prophylactic lidocaine in the early phase of suspected myocardial infarction. Am Heart J . 1985;;110:353-362.
38 +
Koster RW, Dunning AJ.  Intramuscular lidocaine for prevention of lethal arrhythmias in the prehospitalization phase of acute myocardial infarction. N Engl J Med . 1985;;313:1105-1110.
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Valentine PA, Frew JL, Mashford ML, Sloman JG.  Lidocaine in the prevention of sudden death in the pre-hospital phase of acute infarction: a double-blind study. N Engl J Med . 1974;;291:1327-1331.
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Wennerblom B, Holmberg S, Ryden L, Wedel H.  Antiarrhythmic efficacy and side effects of lidocaine given in the prehospital phase of acute myocardial infarction. Eur Heart J . 1982;;3:516-524.
41 +
Klinke WP, Melendez LJ, Peretz DI, Williams JH.  Prophylactic antiarrhythmic therapy with oral tocainide in acute myocardial infarction. Curr Ther Res . 1984;;35:840-849.
42 +
Campbell RWF. Prophylactic administration of tocainide in acute myocardial infarction. In: Pottage A, Ryden L, eds. Proceedings of the Workshop on Tocainide; Copenhagen, Denmark; 1979:141-143.
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Campbell RWF, Hutton I, Elton RA, Goodfellow RM, Taylor E.  Prophylaxis of primary ventricular fibrillation with tocainide in acute myocardial infarction. Br Heart J . 1983;;49:557-563.
44 +
Ryden L, Amman K, Conradson T-B, Hofvendahl S, Mortensen O, Smedgard P.  Prophylaxis of ventricular tachyarrhythmias with intravenous and oral tocainide in patients with and recovering from acute myocardial infarction. Am Heart J . 1980;; 100:1006-1012.
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Halinen MO, Pentikainen PJ, Helin MJ, Rehrberg S.  Antiarrhythmic efficacy of combined intravenous and oral mexiletine in acute myocardial infarction: a double blind placebo-controlled study. Eur Heart J . 1984;;5:675-683.
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Campbell RWF, Achuff SC, Pottage A, Murray A, Prescott LF, Julian DG.  Mexiletine in the prophylaxis of ventricular arrhythmias during acute myocardial infarction. J Cardiovasc Pharmacol . 1979;;1:43-52.
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Smyllie HC, Doar JW, Head CD, Leggett RJE.  A trial of intravenous and oral mexiletine in acute myocardial infarction. Eur J Clin Pharmacol . 1984;; 26:537-542.
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Bell JA, Thomas JM, Isaacson JR, Snell NJC, Holt DW.  A trial of prophylactic mexiletine in home coronary care. Br Heart J . 1982;;48:285-290.
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Chamberlain DA, Jewitt DE, Julian DG, Campbell RWF, Boyle DMcC, Shanks RG.  Oral mexiletine in high-risk patients after myocardial infarction. Lancet . 1980;;2:1324-1327.
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To understand the clinical management of acute heart failure syndromes.
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