Heart failure: myocardial infarction : amiodarone reduces mortality

Clinical bottom line (level 1a)

  1. Amiodarone reduces mortality in patients with congestive heart failure or a history of myocardial infarction (NNT = 72 at 12 months) .
Amiodarone Trials Meta-analysis Investigators : Lancet 1997; 350: 1417-1424
Expires July 2003

The study

Systematic review of randomised controlled trials of
  • Patients: congestive heart failure or history of myocardial infarction
  • Intervention: amiodarone compared with placebo
  • Outcome: all-cause mortality, arrhythmic or sudden death


    • Articles found in ? using not given, ? (search terms: no details given ) and studies identified by literature review, computerised literature search and discussion with colleagues

    Selection criteria: as above
    Appraisal criteria: not detailed
    Articles excluded if:

    eight studies were found of 5101 patients with MI; 5 studies were found of 1452 patients with CHF (83% male; aged mean 61 years, 89% with a history of MI, mean left ventricular ejection fraction 31%)
    Heterogeneity was noted.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    all cause mortality 12 months /
    (12.0%)    		 0.87
    (0.78 to 0.99)     		72
    (42 to 950)
    arrhythmic or sudden death 12 months /
    (4.65%)    		 0.71
    (0.59 to 0.85)     		77
    (54 to 150)

    • 29% of patient discontinued amiodarone early.
    • No difference in benefit was noted for subgroups defined by sex, NYHA class, age, ventricular premature depolarisations or ventricular tachycardia.

    Comments

    1. Details about the search strategy were not given (neither the database used or the search terms).
    2. Individual patient data used

    Citation

    1. Amiodarone Trials Meta-analysis Investigators , : Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data for 6500 patients in randomised trials. Lancet 1997; 350: 1417-1424
    Contributor: Chris Ball and Clare Wotton, July 2000
    Reviewer: Catherine Otto

    Clinical Question.
    Patient heart failure or history of MI
    Intervention or Exposure amiodarone
    Comparison placebo
    Outcome mortality