Cardiac Arrest Study Hamburg (CASH)

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Background

The CASH trial was a randomized, multicenter secondary prevention trials. Patients resuscitated from cardiac arrest secondary to documented VT/ VF unrelated to myocardial infarction were randomized to ICD, amiodarone, metoprolol or propafenone.

Results

This was a small trial. ICD (n=99), amiodarone (n=92), metoprolol (n=97), and propafenone (n=58). The mean follow-up was for 51 ± 34 months. The propafenone arm of the trial was discontinued when an interim analysis demonstrated a 61% higher all-cause mortality in propafenone treated patients. The crude death rate in the ICD arm was 36.4% and 44.4% in the drug arm. The crude death rates in both amiodarone and metoprolol arms were similar. The ICD was associated with a better survival at 5 years although the difference was statistically non-significant (23% reduction in all-cause mortality, p = 0.081, hazard ratio 0.76).

References

Kuck K, Cappato R, Siebels J, et al. Randomized Comparison of Antiarrhythmic Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Cardiac Arrest. Circulation. 2000;102-748-754.