Michiel J. Janse, A. John Camm*,
Gerald Frangin**, Desmond G. Julian***, Marek Malik°, Peter J. Schwartz°°.
Dept. of Clinical and Experimental Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, The Netherlands, *Dept. of Cardiological Sciences, St.
George's Hospital Medical School, London, **Sanofi Recherche, Montpellier, France,
***London, °Dept. of Cardiological Sciences, St. George's Hospital Medical School,
London, UK, °°Dept. of Cardiology, Policlinico S. Matteo, Pavia, Italy
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A brief review of the European Myocardial Infarct
Amiodarone Trial (EMIAT) is provided. In this prospective, randomised, placebo-controlled
trial 1486 patients surviving a recent myocardial infarction and having a left ventricular
ejection fraction < 40% were included. There were no differences between the
placebo group and the amiodarone group with respect to all-cause mortality, but there was
a 35% reduction in arrhythmic mortality in the patients treated with amiodarone. The
reduction in arrhythmic deaths was clearly offset by an increase in non-arrhythmic deaths,
and it would therefore be important to identify patients likely to benefit from amiodarone
treatment as well as patients not likely to do so. A retrospective subgroup analysis based
on parameters present before randomisation indicated that amiodarone could be beneficial
in post-infarction patients with a reduced left ventricular ejection fraction, a high
initial heart rate and taking beta-blockers. Since these findings were based on a
retrospective analysis, they must be interpreted with caution. At best, they could lead to
future prospective trials.
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Major clinical trials
EMIAT trial, amiodarone, postinfarction patients, reduced left ventricular ejection
fraction, beta-blockers, high heart rate, mortality risk, R
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