CAST (study)

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CAST ( Cardiac Arrhythmia Suppression Trial ) is the acronym of a clinical study carried out from 1986 to 1998 on the effectiveness of drugs from the group of class I antiarrhythmics in preventing sudden cardiac death after a heart attack .

The results of the study, published in 1991 ( CAST ) and 1992 ( CAST II ) in the New England Journal of Medicine , led to a paradigm shift in the treatment of infarct patients worldwide and made CAST one of the most widely recognized medical studies.

Course of studies

In 1987, 27 centers began to randomize and double-blindly subject patients after a heart attack to treatment with flecainide , encainide and moricizine or placebo , if they reacted to the drug treatment with a reduction in the number of ventricular extrasystoles in an initial test phase .

The study was conducted in two study arms. In one arm, a total of 1455 patients were treated with encainide, flecainide or placebo, and in the other arm 272 patients were initially treated with moricizine or placebo. In April 1989, the encainide / flecainide arm was terminated due to increased mortality during treatment with the verum (Latin for "the real thing", as opposed to the dummy drug, the placebo). The study then continued with 1,300 patients in the moricizin arm, until this was also discontinued in August 1991 because of an increased incidence of deaths compared to placebo treatment. Data collection continued until March 1998.

Results

CAST I was discontinued after 10 months because the mortality rate under drug treatment (8.3%) was significantly higher than under placebo (3.5%; p = 0.001). Sudden cardiac death was the predominant cause of death.

In CAST II, ​​moricizine caused an increase in all-cause mortality from 5.4 to 7.2 percent, with the difference being significant in the first two weeks.

These results were confirmed in a meta-analysis published in 1993. In the evaluation of 51 randomized studies, a total of 11,712 infarct patients after treatment with class I antiarrhythmic drugs showed a higher mortality (5.6%) than in 11,517 patients after placebo treatment (5.0%; p = 0.03).

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  1. ↑ DS Echt et al. For the CAST Investigators: Mortality and morbidity in patients receiving encainide, flecainide, or placebo . In: N Engl J Med. 324, 1991, pp. 781-788.
  2. ↑ a b The Cardiac Arrhythmia Suppression Trial II Investigators: Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction . In: N Engl J Med. 327, 1992, pp. 227-233.
  3. ↑ B. Lüderitz, W. Jung: Antiarrhythmic therapy in post-infarction patients. In: Deutsches Ärzteblatt . 94, 1997, pp. A-1345. online (accessed May 8, 2014)
  4. ↑ ClinicalTrials.gov: Cardiac Arrhythmia Suppression Trial (CAST) . online (accessed February 16, 2007).
  5. ↑ KK Teo, S. Yusuf, CD Furberg: Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction. An overview of results from randomized controlled trials. In: JAMA. 270, 1993, pp. 1589-1595. PMID 8371471 .