Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomised trials

Meta Analysis ◽

Insuficiencia Cardiaca

La amiodarona es un medicamento anti arrítmico que se usa como profilaxis después de un infarto agudo de miocardio (IM) y en pacientes con insuficiencia cardíaca congestiva (ICC). Este estudio tiene como objetivo reevaluar los beneficios y daños clínicos de la amiodarona en pacientes con IM y CHF, según los datos del estudio Amiodarone Trials Meta-Analysis Investigators (ATMAI). Con este objetivo, realizamos un nuevo análisis de ATMAI donde dos autores extrajeron la información de los ensayos incluidos de forma independiente; y otros dos autores comprobaron la veracidad de la información. De los 13 ensayos incluidos (6553 pacientes), ocho ensayos (5101 pacientes) se realizaron en pacientes con IM y cinco ensayos (1452 pacientes) se realizaron en pacientes con ICC. En general, la evidencia fue de baja a modesta, para todos los resultados debido al sesgo (principalmente selección y deserción) y la imprecisión. Para los pacientes con IM, la amiodarona mostró un mayor riesgo de efectos secundarios (RR 1,72; IC del 95%: 1,32 a 2,25 I2: 74%) sin beneficio alguno en la disminución del riesgo de mortalidad por todas las causas (RR 0,87; IC del 95%: 0,69 a 1,1 I2: 40%) en comparación con el placebo o ningún tratamiento. La amiodarona, sin embargo, se asoció con un menor riesgo de mortalidad cardíaca (RR 0,83; IC del 95%: 0,7 a 0,99 I2: 0%) en comparación con placebo o ningún tratamiento. Para los pacientes con ICC, no hubo diferencias entre la amiodarona y el placebo o ningún tratamiento, con respecto a la mortalidad por todas las causas (RR0,86; IC del 95%: 0,71 a 1,04 I2: 26%) y la mortalidad cardíaca (RR 0,82; IC del 95%: 0,64 a 1,04 I2 : 24%). Por tanto, nuestros resultados no apoyan las conclusiones de ATMAI con respecto al efecto beneficioso de la amiodarona en la disminución de la mortalidad en pacientes con IM o ICC. La amiodarona se asoció más bien, con un alto riesgo de eventos adversos en personas con IM. El análisis secuencial de ensayos mostró que no se necesitan más ensayos.

Influence of Age on the Prognostic Importance of Left Ventricular Dysfunction and Congestive Heart Failure on Long-Term Survival After Acute Myocardial Infarction

The American Journal of Cardiology ◽

10.1016/s0002-9149(96)00250-0 ◽

1996 ◽

Vol 78 (2) ◽

pp. 158-162 ◽

Cited By ~ 4

Author(s):

L Køber, MD

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Term Survival ◽

Prognostic Importance

Importance of chronic obstructive pulmonary disease for prognosis and diagnosis of congestive heart failure in patients with acute myocardial infarction

European Journal of Heart Failure ◽

10.1016/s1388-9842(03)00171-5 ◽

2003 ◽

Author(s):

E Kjøller

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

Twenty-Year (1975-1995) Community-wide Trends in the Incidence and In-hospital Case-Fatality Rates (CFR's) Associated With Congestive Heart Failure (CHF) Complicating Acute Myocardial Infarction (AMI): The Worcester Heart Attack Study

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)85030-9 ◽

1998 ◽

Vol 31 (2) ◽

pp. 304A

Author(s):

M Hatton

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Heart Attack ◽

Case Fatality ◽

Hospital Case

Trends in mortality, co-morbidity and treatment after acute myocardial infarction in patients with rheumatoid arthritis 1998–2013

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619896069 ◽

2020 ◽

Vol 9 (8) ◽

pp. 931-938 ◽

Cited By ~ 1

Author(s):

Mattias Skielta ◽

Lars Söderström ◽

Solbritt Rantapää-Dahlqvist ◽

Solveig W Jonsson ◽

Thomas Mooe

Keyword(s):

Rheumatoid Arthritis ◽

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Cox Regression Analysis ◽

Co Morbidity ◽

One Year ◽

Over Time

Aims: Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998–2013. Furthermore, we wanted to identify characteristics associated with mortality. Methods and results: Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998–2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998–2013. Conclusions: The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.