Myocardial infarction: lidocaine increases death.

Clinical bottom line (level 1a)

  1. Patients with acute myocardial infarction who are given prophylactic lidocaine in-hospital, are more likely to die than those given a control (NNT = 34 at unknown) .
  2. Patients given prophylactic lidocaine pre-hospital, have no clear difference in mortality than those given a control.
Hine et al: Archives of Internal Medicine 1989; 149: 2694-2698
Expires October 2004

The study

Systematic review of published, randomised controlled trials of
  • Patients: acute myocardial infarction
  • Intervention: prophylactic lidocaine compared with control
  • Outcome: mortality


    • Articles found in English using MEDLINE, 1966 to 1987 (search terms: not given ) and weekly reviews of Current Contents: Clinical Practice; supplementary hand searches of references in reviews and published trials

    Selection criteria: As above and enrolment within 72 hours of symptoms; lidocaine dosing in a fashion consistent with current medical practice
    Appraisal criteria: detailed in test
    Articles excluded if: not given

    14 trials with 9063 patients
    no evidence of heterogeneity from two statistical methods- combined estimate of odds ratios and a weighted average of the risk differences for the individual trials

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    mortality from hospital phase data unknown 73
    (1.97%)
    (%)    		 %
    (% to %)    		 0.029%
    (0.004% to 0.055%)    		 34
    (18 to 250)
    mortality from pre-hospital phase data unknown 64
    (9.1%)
    (%)    		 %
    (% to %)    		 0.02%
    (-0.05% to 0.01%)    		 54
    (NNT = 83 to infinity;
    NNH = 21 to infinity)

    • Meta-analysis produced results as absolute risk differences.

    Comments

    1. The study is extended further in the Sadowski 1999 paper, with similar conclusions.

    Citation

    1. Hine LK, Laird N, Hewitt P, et al: Meta-analytic evidence against prophylactic use of lidocaine in acute myocardial infarction. Archives of Internal Medicine 1989; 149: 2694-2698
    Contributor: Clare Wotton and Bob Phillips, October 1999
    Reviewer:

    Clinical Question.
    Patient acute myocardial infarction
    Intervention or Exposure prophylactic lidocaine
    Comparison placebo
    Outcome mortality