Prophylactic lidocaine for myocardial infarction

Area of Science:

• Cardiology
• Clinical Trials
• Pharmacology

Background:

• Coronary artery disease (CAD) and acute coronary syndromes (ACS) are significant global health issues.
• Ventricular arrhythmia post-myocardial infarction (MI) poses a high mortality risk.
• Existing evidence on prophylactic lidocaine's efficacy and safety in MI is outdated and uncertain.

Purpose of the Study:

• To evaluate the clinical effectiveness and safety of prophylactic lidocaine in preventing death among myocardial infarction (MI) patients.
• To synthesize evidence from randomized controlled trials (RCTs) on lidocaine's impact on mortality and ventricular fibrillation.

Main Methods:

• Systematic review and meta-analysis of 37 RCTs involving 11,948 participants.
• Searched multiple databases (CENTRAL, MEDLINE, EMBASE, LILACS, Web of Science) with no language restrictions.
• Assessed risk of bias, performed duplicate data extraction, and used random-effects models with trial sequential analysis.

Main Results:

• Lidocaine showed no significant difference compared to placebo/no intervention for all-cause mortality (RR 1.02), cardiac mortality (RR 1.03), or ventricular fibrillation (RR 0.78).
• Evidence quality was low to very low for most outcomes.
• Lidocaine increased the risk of asystole (RR 2.32) and dizziness/drowsiness (RR 3.85), with poorly reported safety data.

Conclusions:

• Low-quality evidence suggests prophylactic lidocaine has minimal to no effect on mortality or ventricular fibrillation in acute MI.
• The safety profile of lidocaine remains unclear due to high risk of bias and poor reporting in included trials.
• Trial sequential analysis indicates further trials may not be necessary to rule out a 20% relative risk reduction.