Avanzini F, Latini R, Maggioni A, Colombo F, Santoro E, Franzosi M G, Tognoni G
Mario Negri Institute of Pharmacological Research, Milan, Italy.
Arch Intern Med. 1995 May 22;155(10):1041-5.
Recent clinical trials have shown increased, rather than decreased, mortality in patients treated with antiarrhythmic drugs after acute myocardial infarction.
To determine whether these findings had an impact on prescription of antiarrhythmic drugs after acute myocardial infarction.
We retrospectively analyzed the class I and III antiarrhythmic prescription data of 38,072 patients with acute myocardial infarction enrolled in three large randomized clinical trials endorsed by a highly representative sample (about 75%) of Italian coronary care units during the last 10 years. The first study was conducted in 1984 to 1985; the second, in 1988 to 1989; the pilot for the third, in 1991; and the third, in 1991 to 1994.
Total class I and III antiarrhythmic prescriptions after acute myocardial infarction was halved during the last decade, from 11.9% at discharge and 14.4% at follow-up in 1984 to 1985 to 5.8% and 5.8%, respectively, in 1991 to 1994. The trend was independent of the different distributions in the three studies of the patients' characteristics associated with antiarrhythmic use (ie, age > or = 70 years, anterior acute myocardial infarction, ventricular fibrillation during hospitalization, and Killip class > or = 2 at randomization). The same decreasing trend was observed for each antiarrhythmic drug. The drug most widely used was amiodarone, accounting for about half of the antiarrhythmic prescriptions, followed by mexiletine hydrochloride and propafenone hydrochloride; flecainide acetate was dropped from the prescription list after the publication of the Cardiac Arrhythmia Suppression Trial results.
The negative results of the recent clinical trials on class I antiarrhythmic drug use after acute myocardial infarction have been rapidly transferred into routine clinical practice in Italy, since the proportion of patients who received class I and III antiarrhythmic drugs after acute myocardial infarction was halved from the early 1980s to the early 1990s.
近期临床试验表明，急性心肌梗死后接受抗心律失常药物治疗的患者死亡率有所上升，而非下降。
确定这些研究结果是否会对急性心肌梗死后抗心律失常药物的处方产生影响。
我们回顾性分析了38072例急性心肌梗死患者的I类和III类抗心律失常药物处方数据，这些患者参与了过去10年中由意大利约75%具有高度代表性的冠心病监护病房认可的三项大型随机临床试验。第一项研究于1984年至1985年进行；第二项于1988年至1989年进行；第三项的前期试验于1991年进行；第三项于1991年至1994年进行。
在过去十年中，急性心肌梗死后I类和III类抗心律失常药物的总处方量减半，从1984年至1985年出院时的11.9%和随访时的14.4%降至1991年至1994年的5.8%和5.8%。这种趋势与三项研究中与抗心律失常药物使用相关的患者特征（即年龄≥70岁、前壁急性心肌梗死、住院期间室颤以及随机分组时Killip分级≥2级）的不同分布无关。每种抗心律失常药物都观察到相同的下降趋势。使用最广泛的药物是胺碘酮，约占抗心律失常药物处方的一半，其次是盐酸美西律和盐酸普罗帕酮；在心律失常抑制试验结果公布后，醋酸氟卡尼从处方清单中删除。
近期关于急性心肌梗死后使用I类抗心律失常药物的临床试验的负面结果已迅速转化为意大利的常规临床实践，因为从20世纪80年代初到90年代初，急性心肌梗死后接受I类和III类抗心律失常药物治疗的患者比例减半。
