Are coronary patients at higher risk with digoxin therapy? An ongoing controversy

Previous reports have yielded contradictory conclusions regarding the safet y of digoxin therapy in patients with acute myocardial infarction. The purp ose of our study was to determine whether digoxin therapy is associated wit h increased mortality in patients with chronic coronary artery disease. We analyzed data from 8173 patients who were screened for participation in the Bezafibrate Infarction Prevention (BIP) trial and who survived an acute my ocardial infarction at least 6 months prior to the study. Three-year overal l mortality of the 451 (15.5%) patients receiving digoxin (according to the judgement of their treating physician) at the time of screening for BIP pa rticipation, was 22.4% compared to 8.3% in the patients who did not receive digoxin. Cardiac mortality was 16.2% in the digoxin-treated group, compare d to 4.9% in the non-treated patients. The increased risk associated with d igoxin remained statistically significant when patients were stratified acc ording to sex, age groups, functional capacity and the presence of hyperten sion, diabetes or angina. The administration of digoxin to survivors of an acute myocardial infarction in the chronic phase of their disease, is stati stically associated with a 30-50% increase in the risk of overall and cardi ac mortality during long-term follow-up. A propensity of increased risk of arrhythmias in ischemic coronary patients may explain this finding. (C) 199 9 Elsevier Science Ireland Ltd. All rights reserved.