Which landmark randomised trial demonstrated that suppressing asymptomatic ventricular premature complexes after myocardial infarction with class IC agents actually increased mortality?

• A SOLVD
• B CONSENSUS
• C ALLHAT
• D CAST (Cardiac Arrhythmia Suppression Trial) ✓

Explanation

CAST tested encainide and flecainide (with moricizine in CAST II) in post-infarction patients with asymptomatic ventricular ectopy. Despite effective suppression of premature complexes, both encainide and flecainide arms showed roughly two to three fold higher mortality than placebo, attributed to proarrhythmic sudden death. This trial permanently restricted class IC drugs to patients without structural heart disease. CONSENSUS, SOLVD and ALLHAT concerned ACE inhibitors and antihypertensive outcomes, not antiarrhythmic suppression.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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