title: Does exercise-induced ST-segment depression predict benefit of medical intervention in patients recovering from acute myocardial infarction? The Danish Study Group on Verapamil in Myocardial Infarction.
abstract: The present study tested the hypothesis that the increased risk in patients with exercise-provoked ST-segment depression recovering from acute myocardial infarction could by abolished by anti-ischaemic medical intervention. Prior to discharge a symptom-limited exercise test was carried out. Patients were then double-blindly randomized to treatment with either verapamil 120 mg t.i.d. or placebo, and observed for up to 18 months (mean 17 months). End-point was first major event; i.e. non-fatal reinfarction or death. Two-hundred-and-ninety-eight patients were included. Forty-four patients with and 111 without exercise-induced ischaemia were randomized to verapamil and 39 and 104 respectively, to placebo. The overall number of events was 12.5%. In patients without ST-segment depression, 12.5% in the placebo group (hazard = 1) and 12.6% in the verapamil group (hazard = 1.13) had an event (NS). In patients with ST-segment depression 15.4% in the placebo group (hazard = 1.20) and 9.1% in the verapamil group (hazard = 0.85) had an event (NS). The latter reduction (41%) supports the hypothesis that patients with ST-segment depression, i.e. residual myocardial ischaemia, are those who benefit from anti-ischaemic intervention after myocardial infarction.
authors.forename: C M
authors.initials: CM
authors.lastname: Jespersen
authors.forename: L
authors.initials: L
authors.lastname: Hagerup
authors.forename: N
authors.initials: N
authors.lastname: Holländer
authors.forename: P E
authors.initials: PE
authors.lastname: Hven
authors.forename: J
authors.initials: J
authors.lastname: Launbjerg
authors.forename: N C
authors.initials: NC
authors.lastname: Linde
authors.forename: J
authors.initials: J
authors.lastname: Nielsen
authors.forename: E
authors.initials: E
authors.lastname: Steinmetz
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D014700:Verapamil