Myocardial infarction: prophylactic amiodarone decreases mortality rates.

Clinical bottom line (level 1a)

  1. Patients with acute myocardial infarction or congestive heart failure who are given prophylactic amiodarone are less likely to die than those given placebo or usual care (NNT = 97 at unknown) .
  2. Patients given amiodarone are less likely to die from arrhythmia/sudden death (NNT = 90 at unknown) .
Amiodarone Trials Meta-Analysis Investigators : Lancet 1997; 350: 1417-1424
Expires October 2004

The study

Systematic review of individual patient data from randomised trials of
  • Patients: acute myocardial infarction or congestive heart failure
  • Intervention: amiodarone compared with placebo or usual care
  • Outcome: all-cause mortality and arrhythmic/sudden death


    • Articles found in ? languages using ? databases, ? dates (search terms: not given ) and stated "literature review, computerised literature search and discussion with colleagues"

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: ?

    13 trials of MI (5101 patients) and 5 of CCF (1452 patients)
    • Baseline characteristics were similar between the patient populations, with 83% being male and a mean age of 61 years.
    • All trials used a loading dose of amiodarone between 400 mg/day for 28 days and 800 mg/day for 14 days.
    Heterogeneity was borderline statistically significant for total mortality, but not for arrythmia/sudden death.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    total mortality unknown 563/6553
    (8.60%)    		 0.87
    (0.78 to 0.99)     		97
    (57 to 1272)
    arrhythmic/sudden death unknown 259/6553
    (3.95%)    		 0.71
    (0.59 to 0.85)     		90
    (63.0 to 175)

    • Similar results were found in the CCF and MI subgroups, and those with poor (<35% EF) and good left ventricular function

    Citation

    1. Amiodarone Trials Meta-Analysis Investigators , : The effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: A meta-analysis of individual data from 6500 patients in 13 randomised trials. Lancet 1997; 350: 1417-1424
    Contributor: Clare Wotton and Bob Phillips, October 1999
    Reviewer:

    Clinical Question.
    Patient acute myocardial infarction and congestive heart failure
    Intervention or Exposure amiodarone
    Comparison placebo
    Outcome mortality