title: Meta-analytic evidence against prophylactic use of lidocaine in acute myocardial infarction.
abstract: Although lidocaine prophylaxis reduces the incidence of ventricular fibrillation during acute myocardial infarction (AMI), randomized control trials (RCTs) have not demonstrated any significant mortality effect of this therapy. We conducted a meta-analysis of 14 RCTs of lidocaine prophylaxis during AMI to detect any mortality effect. Six prehospital- and eight hospital-phase RCTs that randomized totals of 7656 and 1407 patients, respectively, were selected and reviewed in a blinded fashion. Mortality data were evaluated according to therapy type, reporting interval, and patient category. The prehospital-phase RCTs showed no meaningful mortality effect (risk difference, 0.0184; 95% confidence interval, -0.048 to +0.012). The hospital-phase RCTs showed a statistically significant increase in mortality during the treatment period for lidocaine recipients (risk difference, 0.029; 95% confidence interval, +0.004 to +0.055). These results confirm that lidocaine administered to monitored patients during the prehospital phase of AMI will not reduce mortality by a clinically important amount and suggest that lidocaine administered in the hospital phase of monitored, uncomplicated AMI may increase mortality among recipients with proved AMI.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass 02115.
authors.forename: L K
authors.initials: LK
authors.lastname: Hine
authors.forename: N
authors.initials: N
authors.lastname: Laird
authors.forename: P
authors.initials: P
authors.lastname: Hewitt
authors.forename: T C
authors.initials: TC
authors.lastname: Chalmers
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D015201:Meta-Analysis as Topic; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D011897:Random Allocation; D016019:Survival Analysis
chemical_list: D008012:Lidocaine