Pharmacological treatment during AMI and in secondary prevention: the scientific evidence

Table 11. Antiarrhythmics (post infarct). Effect on mortality.
STUDIES DRUG No. PATIENTS FOLLOW-UP VAR. P
CLASS I
CAST (1991) [22] ENCAINIDE
FLECAINIDE		 1,498 10 MONTHS +164% <0.001
CAST-II (1992) [13] MORICIZINE 1,325 14 DAYS +234% 0.02
CLASS III
JULIAN (1982) [50] l-SOTALOL 1,456 1 YEAR -19% 0.30
BASIS (1990) [10] AMIODARONE 213 12 MONTHS -61% <0.05
CEREMIZYNSKI (1992) [15] AMIODARONE 613 12 MONTHS -38% 0.10
SWORD (1996) [95] d-SOTALOL 3,121 148 DAYS +65% 0.006
EMIAT (1997) [51] AMIODARONE 1,486 21 MONTHS +1% 0.96
CAMIAT (1997) [11] AMIODARONE 1,202 1.8 YEAR -18% 0.129
 
META-ANALYSES No. STUDIES No. PATIENTS   VAR. P
During infarction
MCMAHON (1988) [57] 14 9,155   +38% >0.05
After infarction
CLASS I
TEO (1993) [93] 18 6,300   +21% 0.04
CLASS III (AMIODARONE)
TEO (1993) [93] 9 1,557   -29% 0.03

 

ACC/AHA GUIDELINES

  • No Holter indicated after AMI, Class I drugs and l/d-sotalol not indicated, consider amiodarone if serious symptomatic arrhythmias

ANMCO-SIC CLINICAL GUIDELINES

  • Documentation of major ventricular arrhythmias (prolonged VT) justifies adding amiodarone to the treatment