title: Review of calcium antagonist trials in acute myocardial infarction.
abstract: Nine randomized trials in patients with acute myocardial infarction have been performed to assess the effect of nifedipine on infarct size, reinfarction and/or survival. In none of the trials was there any benefit and in some there was a deleterious effect. In the most recent trial, SPRINT II, the study was stopped prematurely-because of deleterious side effects in the diltiazem-treated group. Thus, nifedipine is not recommended in patients with acute myocardial infarction or postmyocardial infarction for prevention of reinfarction or death, and further trials are not necessary. In a single study involving 1,436 patients, verapamil showed no statistical benefit on reinfarction or survival, but due to a high drop-out rate, the result appears less than definitive. A second trial has been completed but results are not yet available. In a randomized, double-blind short-term (2 weeks) trial consisting of 576 patients with non-Q-wave infarction, diltiazem caused a 50% reduction in the incidence of reinfarction and refractory angina. In a long-term trial (12-52 mos.) consisting of 2,466 patients with Q- and non-Q-infarction, there was no benefit overall, but in the patients without failure (80%) there was a 28% reduction in cardiac events. In the patients with non-Q-infarction (634), there was a 40% reduction in cardiac events, and at the end of 4-5 years there was still a reduction of 34% in the diltiazem group. In patients admitted to the study with failure, the mortality was increased in patients with Q- or non-Q-infarction. Thus, diltiazem is recommended for routine prophylaxis in patients with non-Q-infarction without cardiac failure.
authors.affiliation: Bugher Foundation Center for Molecular Biology in the Cardiovascular System, Baylor College of Medicine, Methodist Hospital, Houston, Texas 77030.
authors.forename: R
authors.initials: R
authors.lastname: Roberts
mesh_terms: D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004110:Diltiazem / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D009543:Nifedipine / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D002121:Calcium Channel Blockers; D014700:Verapamil; D004110:Diltiazem; D009543:Nifedipine