Morbidity and mortality following early administration of amiodarone in acute myocardial infarction

Aims The objective of this study was to ascertain the effect of intravenous and oral amiodarone on morbidity and mortality in patients during the firs t hours after the onset of an acute myocardial infarction. Methods and Results A cohort of 1073 patients admitted to the CCU within 24 h of the onset of symptoms of an acute myocardial infarction and heart fai lure (Killip and Kimball A-B) were randomized to receive amiodarone (n = 54 2) or placebo (n = 531) for 6 months. Because of the higher mortality, on a n interim analysis, from a 'high dose' of amiodarone or placebo (516 patien ts) the protocol was changed to a 'low dose' or placebo (557 patients). Mor tality with high doses of amiodarone was 16.30% vs 10.16% in the placebo gr oup (P = 0.04), whereas mortality with low doses was 6.61% vs 9.47% in the control group (P = 0.20). Several non-fatal adverse effects were observed i n 108 and 73 patients treated with amiodarone and placebo, respectively. Conclusion This study demonstrated that early administration of amiodarone in low doses to patients with an acute myocardial infarction may be used on ly if life-threatening arrhythmia justify its prescription Conversely, when given in high doses, it might increase mortality. (C) 2000 The European Society of Cardiology.