Abstract 3595: Amiodarone Use After Acute Myocardial Infarction Complicated by Heart Failure and/or Left Ventricular Dysfunction Is Associated with Excess Mortality
Introduction. The Sudden Cardiac Death in Heart Failure trial suggested that amiodarone was associated with increased mortality among patients with an ejection fraction ≤35% and severe HF. Prior randomized controlled trial results of amiodarone in HF have largely shown a neutral effect on mortality; however, pharmacotherapy for HF has evolved substantially. Our goal was to assess the effect of amiodarone use on mortality during consecutive time periods in post acute MI patients with LVSD and/or HF treated with a contemporary medical regimen.
Methods. We compared the baseline characteristics of 14,700 patients (825 treated with amiodarone) enrolled in VALIANT; a randomized trial of valsartan, captopril, or both in acute MI patients with HF and/or LVSD. Using Cox models, we examined the association of amiodarone use with mortality during various time 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 had a history of more comorbidities. Adjusting for baseline predictors of mortality, amiodarone use was associated with a significant increase in mortality during 3 of the 4 time periods, HR and 95% CI, 1.5 (1.1–2.0), P=0.02 for days 1–16; 2.1 (1.5–2.9), P≤0.001 for days 17– 45; and 1.4 (1.2–1.6), P≤0.001 for days 199–1096.
Conclusions. In this contemporary study of post acute MI patients with HF or LVSD, amiodarone use appeared to be associated with an excess in early and late all-cause and cardiovascular mortality. These findings are in contrast to earlier randomized trials of amiodarone and need to be validated prospectively.