Amiodarone reduced the risk of sudden cardiac death compared to placebo or control (7.1% vs. 9.7%; OR 0.71; 95% CI 0.61-0.84; P<0.001), though it increased pulmonary and thyroid toxicity.
Meta-Analysis (n=8,522)
Does amiodarone reduce sudden cardiac death in patients at risk for SCD?
Amiodarone reduces the risk of sudden cardiac death by 29% and cardiovascular death by 18%, offering a viable alternative for patients ineligible for ICDs, though it significantly increases pulmonary and thyroid toxicity.
Odds Ratio: 0.71 (95% CI 0.61–0.84)
Absolute Event Rate: 7.1% vs 9.7%
p-value: p=< 0.001
AIMS: Not all patients at risk for sudden cardiac death (SCD) are eligible for, or have access to implantable cardioverter defibrillator (ICD) implantation. There are conflicting data regarding the efficacy and safety of amiodarone for the prevention of SCD. METHODS AND RESULTS: We conducted a meta-analysis of all randomized controlled trials examining the use of amiodarone vs. placebo/control for the prevention of SCD. We identified 15 trials, which randomized 8522 patients to amiodarone or placebo/control. Amiodarone decreased the incidence of SCD 7.1 vs. 9.7%; OR 0.71 (0.61-0.84), P < 0.001 and cardiovascular death (CVD) 14.0 vs. 16.3%; OR 0.82 (0.71-0.94), P = 0.004. There was a 1.5% absolute risk reduction in all-cause mortality which did not meet statistical significance (P = 0.093). Amiodarone therapy increased the risk of pulmonary 2.9 vs. 1.5%; OR 1.97, (1.27-3.04), P = 0.002, and thyroid 3.6 vs. 0.4%; OR 5.68, (2.94-10.98), P < 0.001 toxicity. CONCLUSION: Amiodarone reduces the risk of SCD by 29% and CVD by 18%, and therefore, represents a viable alternative in patients who are not eligible for or who do not have access to ICD therapy for the prevention of SCD. However, amiodarone therapy is neutral with respect to all-cause mortality and is associated with a two- and five-fold increased risk of pulmonary and thyroid toxicity.
Piccini et al. (Tue,) conducted a meta-analysis in at risk for sudden cardiac death (SCD) (n=8,522). Amiodarone vs. placebo/control was evaluated on sudden cardiac death (SCD) (OR 0.71, 95% CI 0.61-0.84, p=< 0.001). Amiodarone reduced the risk of sudden cardiac death compared to placebo or control (7.1% vs. 9.7%; OR 0.71; 95% CI 0.61-0.84; P<0.001), though it increased pulmonary and thyroid toxicity.