Amiodarone combined with beta-blockers in post-myocardial infarction patients significantly reduced cardiac death (P=0.05) and arrhythmic death or resuscitated cardiac arrest (P=0.03).
RCT
Yes
Does the combination of amiodarone and beta-blockers reduce mortality and arrhythmic death in post-myocardial infarction patients?
The combination of amiodarone and beta-blockers in post-myocardial infarction patients is safe and synergistically reduces cardiac and arrhythmic deaths.
p-value: p=0.05 and 0.03
BACKGROUND: Investigations with in vitro and animal models suggest an interaction between amiodarone and beta-blockers. The objective of this work was to explore if an interaction with beta-blocker treatment plays a role in the decrease of cardiac arrhythmic deaths with amiodarone in patients recovered from an acute myocardial infarction. METHODS AND RESULTS: A pooled database from 2 similar randomized clinical trials, the European Amiodarone Myocardial Infarction Trial (EMIAT) and the Canadian Amiodarone Myocardial Infarction Trial (CAMIAT), was used. Four groups of post-myocardial infarction patients were defined: beta-blockers and amiodarone used, beta-blockers used alone, amiodarone used alone, and neither used. All analyses were done on an intention-to-treat basis. Unadjusted and adjusted relative risks for all-cause mortality, cardiac death, arrhythmic cardiac death, nonarrhythmic cardiac death, arrhythmic death, or resuscitated cardiac arrest were lower for patients receiving beta-blockers and amiodarone than for those without beta-blockers, with or without amiodarone. The interaction was statistically significant for cardiac death and arrhythmic death or resuscitated cardiac arrest (P=0.05 and 0.03, respectively). Findings were consistent across subgroups. CONCLUSIONS: These findings are based on a post hoc analysis. However, they confirm prior results from in vitro and animal experiments suggesting an interaction between beta-blockers and amiodarone. In practice, not only is the adjunct of amiodarone to beta-blockers not hazardous, but beta-blocker therapy should be continued if possible in patients in whom amiodarone is indicated.
Boutitie et al. (Tue,) conducted a rct in Post-myocardial infarction. Amiodarone and beta-blockers vs. Without beta-blockers, with or without amiodarone was evaluated on Cardiac death and arrhythmic death or resuscitated cardiac arrest (p=0.05 and 0.03). Amiodarone combined with beta-blockers in post-myocardial infarction patients significantly reduced cardiac death (P=0.05) and arrhythmic death or resuscitated cardiac arrest (P=0.03).