Anti-ischaemic intervention with verapamil in patients recovering from acute myocardial infarction.
The present review discusses the prognostic significance of post-infarction angina pectoris, and the significance of post-infarction intervention with verapamil on the prevalence of post-infarction ischaemia and prognosis. Angina pectoris during the first month after acute myocardial infarction (AMI) was found to be a significant predictor of subsequent major events (death and reinfarction) (P = 0.03). The prognosis in patients with post-infarction angina pectoris was as poor as that observed in patients with mild to moderate congestive heart failure. Intervention with verapamil significantly reduced the 1 month prevalence of angina pectoris (P = 0.02), and thereby also the number of patients at high risk. In patients with ST-segment depression provoked during a pre-discharge, post-infarction exercise test, intervention with verapamil reduced major events by 41% compared with placebo. In patients with both heart failure and angina pectoris, anti-ischaemic intervention with verapamil reduced the 17 month event rate by 37%, whereas no effect was found in patients with heart failure, but no angina pectoris. We conclude that angina pectoris following AMI is a significant risk predictor in both patients with and without impaired cardiac function. Intervention with verapamil significantly reduces post-infarction ischaemia, thereby reducing the risk of reinfarction and death.
Jespersen
C M
CM
Department of Cardiology, University of Copenhagen, Hvidovre, Denmark.
D000787:Angina Pectoris / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D014700:Verapamil / Q000627:therapeutic use*
D002121:Calcium Channel Blockers; D014700:Verapamil