Meta-analysis of Empirical Long-term Antiarrhythmic Therapy After Myocardial Infarction

Hine, Louis K.; Laird, Nan M.; Hewitt, Peg; Chalmers, Thomas C.

doi:10.1001/jama.1989.03430210079035

Cited by 97 publications

(15 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Without clinical trial data extrapolation to newer screening strategies or treatments can be dangerous. Furthermore, new tests and treatments may have adverse effects that are not anticipated, such as class I antiarrhythmics in ischaemic heart disease31 or clofibrate in dyslipidaemia 24…”

Section: Discussionmentioning

confidence: 99%

Number needed to screen: development of a statistic for disease screening

Rembold¹

1998

BMJ

324

215

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Number needed to screen: development of a statistic for disease screening

Rembold¹

1998

BMJ

324

215

View full text Add to dashboard Cite

“…Later, a systematic review of the evidence may suggest that the treatment was rather more effective than had been realised—as in the cases of, for example, streptokinase for acute myocardial infarction,1 aspirin for the prevention and treatment of vascular disease,2 tamoxifen and ovarian ablation for breast cancer3—or that it was more hazardous than realised, as in the case of routine antiarrhythmic prophylaxis after myocardial infarction 4. Such systematic reviews may then be followed by large trials or “mega” trials to confirm or refute their findings.…”

Section: Introductionmentioning

confidence: 99%

The miracle of DICE therapy for acute stroke: fact or fictional product of subgroup analysis?

Counsell

Clarke

Slattery

et al. 1994

BMJ

137

View full text Add to dashboard Cite

Objective-To determine whether inappropriate subgroup analysis together with chance could change the conclusion of a systematic review of several randomised trials ofan ineffective treatment.Design-44 randomised controlled trials of DICE therapy for stroke were performed (simulated by rolling different coloured dice; two trials per investigator). Each roll of the dice yielded the outcome (death or survival) for that "patient." Publication bias was also simulated. The results were combined in a systematic review.Setting-Edinburgh. Main outcome measure-Mortality.

show abstract

“…Empiric antiarrhythmic therapy after myocardial infarction in patients without spontaneous sustained VT has been already proven to be ineffective or dangerous [6,[17][18][19]. The CAST study [6] demonstrated that suppression of ventricular premature beats on Holter monitoring by flecainide, encainide, or ethmozime [16] might be associated with a higher risk of cardiac mortality.…”

Section: Discussionmentioning

confidence: 99%

Programmed ventricular stimulation after myocardial infarction does not help reduce the risk of ventricular events

Brembilla‐Perrot¹,

Jacquemin²,

A³

et al. 1996

Cardiovasc Drug Ther

View full text Add to dashboard Cite

Programmed ventricular stimulation could be a useful technique to detect patients at high risk for ventricular arrhythmias and sudden death after acute myocardial infarction. However, prevention of arrhythmic events using this technique has never been demonstrated. To determine whether prophylactic antiarrhythmic therapy influences prognosis after acute myocardial infarction, 196 patients without spontaneous ventricular tachycardia (VT) but with inducible sustained monomorphic VT were followed for 3 +/- 1 years. Ninety-seven patients were not treated (control group). In 99 patients (study group), the antiarrhythmic therapy was guided by electrophysiologic study: One to four trials using class I, II, and III antiarrhythmic drugs were performed until the VT was not inducible or the induced VT was slower and was associated with hemodynamic stability. An effective antiarrhythmic drug prevented VT induction in 34 patients (34%; group I). Sixty-five patients (group II) still had inducible VT with the antiarrhythmic drug. Group II differed from group I in having a higher incidence of an inferior myocardial infarction location (57% vs. 47%; NS), a lower left ventricular ejection fraction (36.5% vs. 41%; NS), a slower rate of induced VT in the control state (227 vs. 255 beats/min; p < 0.05), and a higher number of drug trials (1.9 vs 1.3; p < 0.001). During the follow-up in the control group and in groups I and II, the incidence of total cardiac events was 25%, 15%, and 16% (NS), respectively, and the incidence of total arrhythmic events (VT, sudden death) was 18.5%, 9%, and 12% (NS). Only the risk of VT was reduced (14%, 0%, and 4%; p < 0.05). In conclusion, guided-antiarrhythmic therapy, including class III agents after acute myocardial infarction, was successful in only 34% of patients, and the incidence of arrhythmic events was not significantly decreased. Therefore, programmed ventricular stimulation does not help in managing patients at risk of ventricular arrhythmia after myocardial infarction but could help indicate the need for nonmedical treatment, such as device therapy.

show abstract

Meta-analysis of Empirical Long-term Antiarrhythmic Therapy After Myocardial Infarction

Cited by 97 publications

References 36 publications

Number needed to screen: development of a statistic for disease screening

Number needed to screen: development of a statistic for disease screening

The miracle of DICE therapy for acute stroke: fact or fictional product of subgroup analysis?

Programmed ventricular stimulation after myocardial infarction does not help reduce the risk of ventricular events

Contact Info

Product

Resources

About