CAST AND BEYOND - IMPLICATIONS OF THE CARDIAC-ARRHYTHMIA SUPPRESSION TRIAL
CAST AND BEYOND - IMPLICATIONS OF THE CARDIAC-ARRHYTHMIA SUPPRESSION TRIAL
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DOI：
10.1161/01.cir.81.3.1123
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发表时间：
1990-03-01
期刊：
影响因子：
37.8
通讯作者：
ZIPES, DP
中科院分区：
文献类型：
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作者：
AKHTAR, M;BREITHARDT, G;ZIPES, DP
频发和重复性室性早搏（PVC）已被认为是既往心肌梗死患者心源性猝死风险增加的独立标志物。在此基础上，启动了心律失常抑制试验（CAST），以检验抑制这些室性心律失常将降低心源性猝死发生率的假设。1正如Furberg的评论，2以前在心肌梗死后患者中使用抗心律失常药物的研究在一个或多个方面存在严重缺陷，因此他们无法最终证明所研究的抗心律失常药物抑制室性心律失常是否影响生存率。CAST是一项安慰剂对照、双盲、多中心研究，于1987年6月开始，旨在评价三种抗心律失常药物（恩卡尼、氟卡尼和莫雷西嗪）对心肌梗死伴无症状或轻度症状室性心律失常患者的疗效。在开始后大约22个月，部分研究提前停止，其余部分由于随机分配到恩卡尼或氟卡尼治疗组的患者死亡率过高而进行了显著修改。1该研究继续使用第三种药物莫雷西嗪。CAST是一项重要的研究，有几个原因。这是第一次提供了令人信服的数据，关于一种存在了大约20年并被执业医生广泛应用的抗疟疾治疗模式。CAST的结果可能会导致广泛的抗肿瘤治疗的变化，他们值得仔细考虑。此外，CAST的结果回答了对氟卡尼提出的假设
F requent and repetitive forms of premature ventricular complexes (PVCs) have been rec-ognized as independent markers of increased risk for sudden cardiac death in patients with a previous myocardial infarction. On this basis, the Cardiac Arrhythmic Suppression Trial (CAST) was initiated to test the hypothesis that suppression of these ventricular arrhythmias would reduce the incidence of sudden cardiac death. 1 As critically reviewed by Furberg, 2 previous studies with antiarrhythmic drugs in post-myocardial infarction patients were seriously flawed in one or more ways, such that they could not conclusively demon-strate whether suppression of ventricular arrhythmias by the antiarrhythmic drugs studied affected survival. CAST, a placebo-controlled, double-blind, multi-center study, was initiated in June 1987 to evaluate the effect of three antiarrhythmic drugs (encainide, flecainide, and moricizine) in patients whohad sus-tained a myocardial infarction and had asymptomatic or mildly symptomatic ventricular arrhythmias. Approximately 22 months after its initiation, part of the study was prematurely halted, andthe remaining part was significantly modified because of excessive mortality in the group of patients randomized to treatment with encainide or flecainide. 1 The study is continuing with the third drug, moricizine. CAST is an important study for several reasons. For the first time, convincing data were provided regarding a mode of antiarrhythmic treatment that existed for some 20 years and was widely applied by practicing physicians. The results of CAST may lead to extensive changes in antiarrhythmic therapy, and they merit careful consideration. Also, results from CAST answered the hypotheses posed for flecainide