Background Alcohol withdrawal syndrome, characterized by a hyperadrenergic state with confusion, agitation and hallucinations, has detrimental effects on patient safety in the context of acute myocardial infarction (MI). Unexpected hospitalization and sudden cessation of alcohol consumption may result in adverse outcomes including in-hospital complications, increased length of stay, and death. Strategies for safe and effective patient management have not been rigorously studied. Purpose We conducted a randomized evaluation of lorazepam and ethanol/lorazepam to evaluate the safety and efficacy of two strategies for the prevention of alcohol withdrawal syndrome in patients with acute coronary syndromes. Methods Patients (n=57) with myocardial infarction were screened for alcohol dependence using the CAGE questionnaire and randomized to lorazepam or to ethanol with lorazepam. Demographic group differences and complication rates were analyzed using chi square (categorical variables) and t-tests (continuous variables). Safety (composite complication rates) of the treatment strategy was evaluated using Fisher’s exact test. Length of stay was analyzed using Wilcoxon rank-sum test. Results Safety-associated complication rates (self-extubation, delirium tremens, re-infarction) were not different between groups (24% lorazepam vs. 18% ethanol; p=0.56). A trend toward fewer complications in the ethanol group was noted. In addition, no difference was detected between the treatment groups for days spent in the CCU (6.9% lorazepam vs. 2.4% ethanol; p = 0.32) or overall hospital stay (6.2% lorazepam vs. 6.4% ethanol; p = 0.72). Conclusions These findings suggest that a randomized evaluation of treatment strategies to prevent complications associated with alcohol withdrawal in acute MI is safe and feasible. A larger study may provide important evidence for improving clinical outcomes for patients experiencing alcohol withdrawal during acute myocardial infarction.

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