Document Detail


Multicenter randomized trial and a systematic overview of lidocaine in acute myocardial infarction.
MedLine Citation:
PMID:  10220626     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: More than 20 randomized trials and 4 meta-analyses have been conducted on the use of prophylactic lidocaine in acute myocardial infarction (MI). The results suggest that lidocaine reduces ventricular fibrillation (VF) but increases mortality rates in acute MI. METHODS AND RESULTS: Patients with ST-elevation MI who were examined <6 hours after symptom onset (n = 903) were randomly assigned to either lidocaine or no lidocaine and to either streptokinase and heparin or heparin alone. Lidocaine was given as 4 boluses of 50 mg each every 2 minutes, then an infusion of 3 mg/min for 12 hours, then 2 mg/min for 36 hours. We compared the incidence of in-hospital death and ventricular arrhythmias. We then performed a meta-analysis of prophylactic lidocaine in acute MI that included these and prior trial results. The rates of VF and death with and without lidocaine were calculated for each trial, then odds ratios (OR) with confidence intervals (CI) were calculated for the risk of these events overall with and without lidocaine. Patients given lidocaine in the randomized study had significantly less VF (2.0% vs 5.7% without lidocaine, P =.004) and a trend toward increased mortality rates (9.7% vs 7.0%, P =.145). Meta-analysis revealed nonsignificant trends toward reduced VF (OR 0.71, 95% CI 0.47 to 1. 09) and increased mortality rates (OR 1.12, 95% CI 0.91 to 1.36) with lidocaine. CONCLUSIONS: Lidocaine reduces VF but may adversely affect mortality rates. The routine use of prophylactic lidocaine in acute MI is not recommended.
Authors:
Z P Sadowski; J H Alexander; B Skrabucha; A Dyduszynski; J Kuch; E Nartowicz; G Swiatecka; D F Kong; C B Granger
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Meta-Analysis; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  American heart journal     Volume:  137     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-06-04     Completed Date:  1999-06-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  792-8     Citation Subset:  AIM; IM    
Affiliation:
Institut Kardiologu and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA.
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MeSH Terms
Descriptor/Qualifier:
Anti-Arrhythmia Agents / administration & dosage,  therapeutic use*
Drug Therapy, Combination
Electrocardiography
Female
Fibrinolytic Agents / administration & dosage,  therapeutic use
Follow-Up Studies
Heparin / administration & dosage,  therapeutic use
Hospital Mortality
Humans
Incidence
Infusions, Intravenous
Lidocaine / administration & dosage,  therapeutic use*
Male
Middle Aged
Myocardial Infarction / complications,  drug therapy*,  mortality
Poland / epidemiology
Streptokinase / administration & dosage,  therapeutic use
Tachycardia, Ventricular / epidemiology,  etiology,  prevention & control*
Thrombolytic Therapy
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Fibrinolytic Agents; 137-58-6/Lidocaine; 9005-49-6/Heparin; EC 3.4.-/Streptokinase
Comments/Corrections
Comment In:
Am Heart J. 1999 May;137(5):770-3   [PMID:  10220620 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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