Jh. Alexander et al., Prophylactic lidocaine use in acute myocardial infarction: Incidence and outcomes from two international trials, AM HEART J, 137(5), 1999, pp. 799-805
Citations number
35
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background Early meta-analyses suggested that prophylactic lidocaine use re
duces ventricular Fibrillation but increases mortality rates after acute my
ocardial infarction. We determined the frequency and effect on clinical out
comes with its use in the thrombolytic era.
Methods and Results We studied 43,704 patients enrolled in GUSTO-I or GUSTO
-IIb who had ST-segment elevation, underwent thrombolysis, and survived at
least 1 hour after enrollment. Odds ratios (OR) and confidence intervals (C
l) were calculated for the risk of asystole, atrioventricular block, ventri
cular fibrillation, and ventricular tachycardia during hospitalization; For
24-hour, in-hospital, and 30-day mortality rates; and for 24-hour and 30-d
ay mortality rates after adjustment for baseline predictors of death. In GU
STO-I and GUSTO-IIb, 16% and 3.5% of patients, respectively, received proph
ylactic lidocaine. They had a lower risk of death at 24 hours (OR 0.81, 95%
Cl 0.67 to 0.97) and trends toward lower odds of in-hospital death (OR 0.9
0, 95% Cl 0.81 to 1.01) and death at 30 days (OR 0.92, 95% Cl 0.82 to 1.02)
. After adjustment for baseline characteristics, however, the odds of death
were similar with or without lidocaine (OR 0.90 and 0.97 respectively). Ou
tside the United States, lidocaine was associated with higher incidences of
all serious arrhythmias, but in US patients it conferred a lower likelihoo
d of ventricular fibrillation and no increase in asystole, atrioventricular
block, or mortality rates.
Conclusions Prophylactic lidocaine use has decreased with the advent of thr
ombolysis, although its use may not be associated with increased mortality
rates.