LidocAine Versus Opioids In MyocarDial infarction: the AVOID-2 randomized controlled trial

Area of Science:

• Cardiology
• Pharmacology
• Emergency Medicine

Background:

• Opioid analgesics can reduce the effectiveness of oral P2Y12 inhibitors.
• There is a need for safe, effective non-opioid pain relief for ischemic chest pain.

Purpose of the Study:

• To compare the efficacy and safety of intravenous lidocaine versus intravenous fentanyl for prehospital analgesia in patients with suspected ST-elevation acute coronary syndromes (STEACS).

Main Methods:

• A prospective, randomized controlled trial (lidocaine Versus Opioids In MyocarDial infarction trial) involving 308 patients with suspected STEACS and moderate to severe pain.
• Patients received either intravenous lidocaine (max 300 mg) or intravenous fentanyl (up to 50 µg every 5 min).
• Co-primary endpoints were prehospital pain reduction and adverse events requiring intervention; secondary endpoints included infarct size and 30-day clinical outcomes.

Main Results:

• Lidocaine showed a statistically significant inferiority in pain reduction compared to fentanyl (P = 0.001).
• Adverse events requiring intervention were significantly lower in the lidocaine group (36%) compared to the fentanyl group (49%) (P = 0.016), meeting non-inferiority and superiority criteria.
• No significant differences were observed in myocardial infarct size or 30-day clinical outcomes between the groups.

Conclusions:

• Intravenous lidocaine was not non-inferior to fentanyl for pain reduction in STEMI but was found to be safe and better tolerated.
• Further trials are warranted to investigate non-opioid analgesics and the clinical benefits of opioid avoidance in STEMI patients.