CAST研究PPT课件.ppt

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1、CAST:CardiacArrhythmiaSuppressionTrialPurposeTodeterminewhethertherapywithclassIcantiarrhythmicstosuppressasymptomaticormildlysymptomaticventriculararrhythmiasafterMIreducesmortalityduetoarrhythmiaReferenceTheCASTInvestigators.Preliminaryreport:effectofencainideandflecainideonmortalityinarand

2、omizedtrialofarrhythmiasuppressionaftermyocardialinfarction.NEnglJMed1989;321:406–12.CAST:CardiacArrhythmiaSuppressionTrial-TRIALDESIGN-DesignMulticenter,multinational;initialphaseopen;mainphaserandomized,double-blind,placebo-controlledPatients1725patientswith>6ventricularprematuredepolarizat

3、ions/h(24hHolterrecording)andleftventricularejectionfraction<0.55at<90daysafterMIor<0.40at>90daysafterMIFollowupandprimaryendpointMean10monthsfollowup.PrimaryendpointdeathfromarrhythmiaTreatmentOpentitrationphase(mean15days)toselectpatientsinwhomdrug(encainide,flecainideormoricizine)suppres

4、sedarrhythmiasSelectedpatientsthenrandomizedtothree-timesdailyplacebo,encainide35–50mg,flecainide100mgormoricizine200–250mg(resultsformoricizinenotreportedhere)CAST:CardiacArrhythmiaSuppressionTrial-RESULTS-Studyofencainide/flecainidevs.placebohaltedatmeanfollowupof10monthsonrecommendationof

5、CASTDataandSafetyMonitoringBoardbecauseingrouptakingencainideorflecainide,comparedwithplacebogroup:All-causemortalitysignificantlyhigherNon-fatalcardiacarrestordeathfromarrhythmiasignificantlyhigherDeathfromothercardiaccausesalsohigherResultsconsistentacrossallsubgroupsexaminedNoconfoundingf

6、actorswereidentifiedtoexplainmarkeddifferencesbetweenencainide/flecainideandplaceboStudysubsequentlymodifiedtocontinuewithmoricizine(CASTII)CAST:CardiacArrhythmiaSuppressionTrial-RESULTScontinued-All-causemortalityDaysafterrandomization050100150200250300350400450500859095100Survival(%)Placebo

7、(n=725)Encainideorflecainide(n=730)CASTInvestigators.NEnglJMed1989;321:406–12.P=0.000380CAST:CardiacArrhythmiaSuppressionTrial-RESULTScontinued-MortalityandcardiacarrestCASTInvestigators.NEnglJMed1989;321:406–12.Non-fatalcardiacarrestordeathf