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Louis K. Hine, MD, MPH; Nan Laird, PhD; Peg Hewitt, MS; Thomas C. Chalmers, MD

Arch Intern Med. 1989;149(12):2694-2698.

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.

(Arch Intern Med. 1989;149:2694-2698)

Author Affiliations
From the Technology Assessment Group, Department of Health Policy and Management (Drs Hine and Chalmers and Ms Hewitt) and Department of Biostatistics (Dr Laird), Harvard School of Public Health, Boston, Mass; Boston Veterans Administration Medical Center (Dr Chalmers); and Clinical Trials Unit, Mount Sinai School of Medicine, New York, NY (Dr Chalmers). Dr Hine is now with the Austin-Travis County Health Department, Austin, Tex.

Footnotes
Accepted for publication July 31, 1989.

Reprint requests to Technology Assessment Group, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (Dr Chalmers).

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