[Which anti-ischemic treatment can be prescribed during and after the acute phase of myocardial infarction?].
After myocardial infarction, calcium channel blockers are the most prescribed anti-ischemic drugs followed by nitrate derivatives and beta blockers. In order to assess whether this attitude is justified by published data on their efficacy, a meta-analysis of trials of anti-ischemic drugs in myocardial infarction was performed. The early mortality was 13.3% in the group treated by IV nitrates in the acute phase of myocardial infarction and 17.2% in control groups, reducing the risk by a quarter (95% confidence interval of the odds ratio (CI): 0.55-0.95). When all nitrate derivative trials were grouped together, the reduction in the risk of death of 21% was significant (from 15% to 11.8%) (CI: 0.59-0.94). Although oral nitrate derivatives introduced during the acute phase and continued for several weeks induced a non-significant reduction in mortality of 16%, when given intravenously, the benefits on early and longer term mortality were unquestionable. The mortality was 9.8% in the groups treated by calcium channel blockers and 9.3% in control groups (NS); the recurrent infarct rate was 4.8% and 5.4% respectively (NS). In this family of drugs, there was no product which distinguished itself from the others with regard to beneficial or adverse effects. The early mortality decreased from 9.2% to 8.2% in the groups treated by oral beta-blockade--a risk reduction of 10% (NS) and from 4.2% to 3.7% with intravenous beta-blockers--a risk reduction of 12% (p = 0.03). Late mortality decreased from 9.4% to 7.6%, a reduction of 20% (p < 0.00001) in long term trials.2+ contraindication of betablockers in patients without cardiac failure.
Service du Pr Delaye, hôpital cardiovasculaire Louis-Pradel, BP Lyon Montchat.
F
F
Delahaye
J L
JL
Genoud
C
C
Colin
G
G
Landrivon
R
R
Ecochard
P
P
Desseigne
A
A
Pinzani
X
X
André-Fouët
J
J
Delaye
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D005996:Nitroglycerin / Q000627:therapeutic use*; D012008:Recurrence
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D005996:Nitroglycerin
Quel traitement anti-ischémique prescrire à la phase aiguë de l'infarctus du myocarde et après?