Myocardial infarction: lidocaine is ineffective given routinely.

Clinical bottom line (level 1a)

  1. Patients with a myocardial infarction who are given lidocaine have no clear difference in mortality or ventricular fibrillation, than those given no lidocaine.
Sadowski et al: American Journal of Cardiology 1999; 137 (5): 792-798
Expires March 2003

The study

Systematic review of randomised controlled trials of
  • Patients: myocardial infarction
  • Intervention: lidocaine compared with no lidocaine
  • Outcome: mortality; ventricular fibrillation (VF)


    • Articles found in - using -, - (search terms: assessment of prior systematic reviews ) and unclear

    Selection criteria: randomised controlled trials
    Appraisal criteria: not stated
    Articles excluded if: not stated

    21 trials with 12385 patients, combined by random effects model, including an original paper which is also reported in this article.
    No significant heterogeneity (by eyeball).

    The evidence

    lidocaine vs placebo
    Outcome Time to outcome CER OR
    (95% CI)    		 NNH
    (95% CI)
    mortality unknown /
    (%)    		 1.12
    (0.91 to 1.36)     		122
    (NNT = 170 to infinity;
    NNH = 44 to infinity)
    ventricular fibrillation weeks /
    (%)    		 0.71
    (0.47 to 1.09)

    Comments

    1. Treatment with lidocaine appears ineffective at reducing death rates, despite its suppression of VF.
    2. The original data is from one of the few randomised trials of lidocaine use in acute ST-elevation MI in the thrombolytic era, and sits squarely with the results of the others.
    3. No stated search methodology weakens the study markedly.

    Citation

    1. Sadowski ZP, Alexander JH, Skrabucha B, et al: Multicenter randomized trial and a systematic overview of lidocaine in acute myocardial infarction. American Journal of Cardiology 1999; 137 (5): 792-798
    Contributor: Bob Phillips and Clare Wotton, November 1999
    Reviewer: Arnold Baas

    Clinical Question.
    Patient myocardial infarction
    Intervention or Exposure administration of lidocaine
    Outcome mortality