Prophylactic lidocaine in acute myocardial infarction: Resurface or reburial?

Autor: Anil V. Yadav, Douglas P. Zipes
Rok vydání: 2004
Předmět:
Zdroj: The American Journal of Cardiology. 94:606-608
ISSN: 0002-9149
DOI: 10.1016/j.amjcard.2004.05.024
Popis: a p ach year in the United States, 5 million patients present to hospitals with chest pain.1 More than 1 illion of these patients are subsequently diagnosed ith acute myocardial infarctions (AMIs). These inlude the subgroups of patients with ST-segment eleation myocardial infarction and non–ST-segment elvation myocardial infarction. Since the 1960s, the volution of the treatment of patients with AMI has hanged dramatically, with the advent of coronary are units, direct percutaneous coronary intervention, nd a full assortment of drugs, including aspirin, cloidogrel, heparin, blockers, angiotensin-converting nzyme inhibitors, glycoprotein IIb/IIIa inhibitors, nd thrombolytics. Each of these drug therapies has ndergone extensive testing to determine its benefits, nd together, they have paved the way for a 50% eduction in mortality from coronary artery disease ver the past 4 decades.2 Notably, this list of drugs that have shown benefit n AMI does not include antiarrhythmic drugs, such as idocaine, which has been regarded as inappropriate rophylactic therapy in AMI.3 This omission may be hought of as puzzling, considering that primary venricular fibrillation (VF), defined as VF in the absence f pulmonary edema or cardiogenic shock, remains an mportant contributor to increased mortality during the rst 24 hours of an AMI. The heated debate about the otential benefit of lidocaine for AMI dates back to he 1960s. During that era, the advent of coronary care nits brought studies that demonstrated that lidocaine uppressed premature ventricular complexes and other o-called warning arrhythmias considered to be haringers of VF in evolving AMI.4 Soon, additional tudies supporting the use of lidocaine to suppress entricular arrhythmias in AMI were conducted.5–8 he major limitations of these early studies included mall sample sizes, a lack of randomization, and inonsistent drug delivery and dosing. Ensuing studies ueled the controversy further by demonstrating that egardless of the incidence of primary VF, no signifcant difference on subsequent mortality could be emonstrated.8,9 Despite the lack of convincing morality data, prophylactic lidocaine in the setting of
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