Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality

Kevin L Thomas; Sana M Al-Khatib; Yuliya Lokhnygina; Scott D Solomon; Lars Valeur Køber; John J V McMurray; Robert M Califf; Eric J Velazquez

doi:10.1016/j.ahj.2007.09.010

Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality

Kevin L Thomas, Sana M Al-Khatib, Yuliya Lokhnygina, Scott D Solomon, Lars Valeur Køber, John J V McMurray, Robert M Califf, Eric J Velazquez

18 Citations (Scopus)

Abstract

BACKGROUND: We sought to assess the association of amiodarone use with mortality during consecutive periods in patients with post-acute myocardial infarction with left ventricular systolic dysfunction and/or HF treated with a contemporary medical regimen. METHODS: This study used data from VALIANT, a randomized comparison of valsartan, captopril, or both in patients with acute myocardial infarction with HF and/or left ventricular systolic dysfunction. We compared baseline characteristics of 825 patients treated with amiodarone at randomization with 13,875 patients not treated with amiodarone. Using Cox models, we examined the association of amiodarone use with subsequent mortality during consecutive periods after randomization (days 1-16, 17-45, 46-198, and 199-1096). RESULTS: Patients treated with amiodarone were older, had higher Killip class, and were more likely to have a history of diabetes mellitus and hypertension. Adjusting for baseline predictors of mortality, we found that amiodarone use was associated with a significant increase in mortality during 3 of the 4 periods: hazard ratio 1.5, 95% CI (1.1-2.0), P = .02, for days 1 to 16; 2.1 (1.5-2.9), P < .001, for days 17 to 45; 1.1 (0.83-1.46), P = .51, for days 46 to 198; and 1.4 (1.2-1.6), P < .001, for days 199 to 1096. CONCLUSION: In this study, amiodarone use was associated with excess early and late all-cause and cardiovascular mortality. These observational findings are in contrast to earlier randomized trials of amiodarone and need to be validated prospectively.

Original language	English
Journal	American Heart Journal
Volume	155
Issue number	1
Pages (from-to)	87-93
Number of pages	6
ISSN	0002-8703
DOIs	https://doi.org/10.1016/j.ahj.2007.09.010
Publication status	Published - 2008

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Thomas, K. L., Al-Khatib, S. M., Lokhnygina, Y., Solomon, S. D., Køber, L. V., McMurray, J. J. V., Califf, R. M., & Velazquez, E. J. (2008). Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality. American Heart Journal, 155(1), 87-93. https://doi.org/10.1016/j.ahj.2007.09.010

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title = "Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality",

abstract = "BACKGROUND: We sought to assess the association of amiodarone use with mortality during consecutive periods in patients with post-acute myocardial infarction with left ventricular systolic dysfunction and/or HF treated with a contemporary medical regimen. METHODS: This study used data from VALIANT, a randomized comparison of valsartan, captopril, or both in patients with acute myocardial infarction with HF and/or left ventricular systolic dysfunction. We compared baseline characteristics of 825 patients treated with amiodarone at randomization with 13,875 patients not treated with amiodarone. Using Cox models, we examined the association of amiodarone use with subsequent mortality during consecutive periods after randomization (days 1-16, 17-45, 46-198, and 199-1096). RESULTS: Patients treated with amiodarone were older, had higher Killip class, and were more likely to have a history of diabetes mellitus and hypertension. Adjusting for baseline predictors of mortality, we found that amiodarone use was associated with a significant increase in mortality during 3 of the 4 periods: hazard ratio 1.5, 95% CI (1.1-2.0), P = .02, for days 1 to 16; 2.1 (1.5-2.9), P < .001, for days 17 to 45; 1.1 (0.83-1.46), P = .51, for days 46 to 198; and 1.4 (1.2-1.6), P < .001, for days 199 to 1096. CONCLUSION: In this study, amiodarone use was associated with excess early and late all-cause and cardiovascular mortality. These observational findings are in contrast to earlier randomized trials of amiodarone and need to be validated prospectively.",

author = "Thomas, {Kevin L} and Al-Khatib, {Sana M} and Yuliya Lokhnygina and Solomon, {Scott D} and K{\o}ber, {Lars Valeur} and McMurray, {John J V} and Califf, {Robert M} and Velazquez, {Eric J}",

note = "Keywords: Aged; Amiodarone; Captopril; Cause of Death; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Heart Failure; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Probability; Proportional Hazards Models; Reference Values; Risk Assessment; Severity of Illness Index; Survival Analysis; Tetrazoles; Treatment Outcome; Valine; Ventricular Dysfunction",

year = "2008",

doi = "10.1016/j.ahj.2007.09.010",

language = "English",

volume = "155",

pages = "87--93",

journal = "American Heart Journal",

issn = "0002-8703",

publisher = "Mosby Inc.",

number = "1",

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TY - JOUR

T1 - Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality

AU - Thomas, Kevin L

AU - Al-Khatib, Sana M

AU - Lokhnygina, Yuliya

AU - Solomon, Scott D

AU - Køber, Lars Valeur

AU - McMurray, John J V

AU - Califf, Robert M

AU - Velazquez, Eric J

N1 - Keywords: Aged; Amiodarone; Captopril; Cause of Death; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Heart Failure; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Probability; Proportional Hazards Models; Reference Values; Risk Assessment; Severity of Illness Index; Survival Analysis; Tetrazoles; Treatment Outcome; Valine; Ventricular Dysfunction

PY - 2008

Y1 - 2008

N2 - BACKGROUND: We sought to assess the association of amiodarone use with mortality during consecutive periods in patients with post-acute myocardial infarction with left ventricular systolic dysfunction and/or HF treated with a contemporary medical regimen. METHODS: This study used data from VALIANT, a randomized comparison of valsartan, captopril, or both in patients with acute myocardial infarction with HF and/or left ventricular systolic dysfunction. We compared baseline characteristics of 825 patients treated with amiodarone at randomization with 13,875 patients not treated with amiodarone. Using Cox models, we examined the association of amiodarone use with subsequent mortality during consecutive periods after randomization (days 1-16, 17-45, 46-198, and 199-1096). RESULTS: Patients treated with amiodarone were older, had higher Killip class, and were more likely to have a history of diabetes mellitus and hypertension. Adjusting for baseline predictors of mortality, we found that amiodarone use was associated with a significant increase in mortality during 3 of the 4 periods: hazard ratio 1.5, 95% CI (1.1-2.0), P = .02, for days 1 to 16; 2.1 (1.5-2.9), P < .001, for days 17 to 45; 1.1 (0.83-1.46), P = .51, for days 46 to 198; and 1.4 (1.2-1.6), P < .001, for days 199 to 1096. CONCLUSION: In this study, amiodarone use was associated with excess early and late all-cause and cardiovascular mortality. These observational findings are in contrast to earlier randomized trials of amiodarone and need to be validated prospectively.

AB - BACKGROUND: We sought to assess the association of amiodarone use with mortality during consecutive periods in patients with post-acute myocardial infarction with left ventricular systolic dysfunction and/or HF treated with a contemporary medical regimen. METHODS: This study used data from VALIANT, a randomized comparison of valsartan, captopril, or both in patients with acute myocardial infarction with HF and/or left ventricular systolic dysfunction. We compared baseline characteristics of 825 patients treated with amiodarone at randomization with 13,875 patients not treated with amiodarone. Using Cox models, we examined the association of amiodarone use with subsequent mortality during consecutive periods after randomization (days 1-16, 17-45, 46-198, and 199-1096). RESULTS: Patients treated with amiodarone were older, had higher Killip class, and were more likely to have a history of diabetes mellitus and hypertension. Adjusting for baseline predictors of mortality, we found that amiodarone use was associated with a significant increase in mortality during 3 of the 4 periods: hazard ratio 1.5, 95% CI (1.1-2.0), P = .02, for days 1 to 16; 2.1 (1.5-2.9), P < .001, for days 17 to 45; 1.1 (0.83-1.46), P = .51, for days 46 to 198; and 1.4 (1.2-1.6), P < .001, for days 199 to 1096. CONCLUSION: In this study, amiodarone use was associated with excess early and late all-cause and cardiovascular mortality. These observational findings are in contrast to earlier randomized trials of amiodarone and need to be validated prospectively.

U2 - 10.1016/j.ahj.2007.09.010

DO - 10.1016/j.ahj.2007.09.010

M3 - Journal article

C2 - 18082495

SN - 0002-8703

VL - 155

SP - 87

EP - 93

JO - American Heart Journal

JF - American Heart Journal

IS - 1

ER -

Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality

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