Prophylactic lidocaine use in acute myocardial infarction: Incidence and outcomes from two international trials☆,☆☆,★,★★
Section snippets
GUSTO-I trial
The GUSTO-I trial has been described in detail.32 Briefly, 41,021 patients from 1081 hospitals in 15 countries were enrolled between December 27, 1990, and February 22, 1993. Inclusion criteria consisted of (1) at least 20 minutes of chest pain beginning within 6 hours before enrollment and (2) accompanying ST-segment elevation of ≥0.1 mV in 2 contiguous limb leads or ≥0.2 mV in 2 contiguous precordial leads.
Patients were randomly assigned to 1 of 4 intravenous thrombolytic strategies: (1)
Results
A total of 40,656 patients in GUSTO-I and 3048 patients in GUSTO-IIb who received thrombolytic therapy and survived at least 1 hour after enrollment were included in our analysis. Table I shows the use of prophylactic lidocaine in GUSTO-I and GUSTO-IIb by place of enrollment.Empty Cell United States Non-US Overall P value GUSTO-I 5826/22,880 (25.5%) 694/17,776 (3.9%) 16.0% <.001† GUSTO-IIb 62/1030 (6.0%) 46/2018 (2.3%) 3.5% <.001 P value <.001 <.001 <.001 *In patients surviving at
Discussion
During GUSTO-I (1990 to 1993), prophylactic lidocaine after acute MI was used widely in the US but not internationally. Presumably because of the results of meta-analyses published during the late 1980s and early 1990s 27, 28, 29 and the ACC/AHA recommendations published in 1990, the use of prophylactic lidocaine declined, both in the US and internationally, between GUSTO-I and GUSTO-IIb.9 Despite this overall decline, during GUSTO-IIb US physicians continued to use prophylactic lidocaine more
Acknowledgements
We thank Pat Williams for editorial assistance and Kerry Bassett for preparing the figures.
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2014, Topics in Companion Animal MedicineCitation Excerpt :Lidocaine, a local anesthetic and antiarrhythmic agent, has traditionally been used for the treatment of ventricular dysrhythmias. The use of IV lidocaine to prevent IRI and systemic inflammatory response syndrome has been described in human medicine and in laboratory animals.45-49 Previous studies in experimentally induced GDV in dog and rat models showed that preischemic lidocaine administration reduced gastric and cardiac histopathologic and ultrastructural tissue damage and cardiac arrhythmias.50
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Guest Editor for this article was Judith S. Hochman, MD, St. Luke’s-Roosevelt Hospital Center, New York, NY.
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Supported by a combined grant from Bayer (New York, NY), CIBA-Corning (Medfield, Mass), Genentech (South San Francisco, Calif), ICI Pharmaceuticals (Wilmington, Del), Sanofi Pharmaceuticals (Paris, France), Ciba-Geigy (Summit, NJ), Boehringer Mannheim (Indianapolis, Ind), and Guidant Corporation (Redwood City, Calif).
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Reprint requests: Christopher B. Granger, MD, Duke Clinical Research Institute, 2024 W Main St, Bay A-1, Durham, NC 27705.
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