Coronary heart disease: verapamil decreases nonfatal reinfarction in cardiovascular disease.

Clinical bottom line (level 1a)

  1. Patients with cardiovascular disease who are given verapamil, are less likely to have a nonfatal reinfarction than those given placebo (NNT = 64 at unknown) .
  2. Patients given verapamil are less likely to have a nonfatal reinfarction and death combined (NNT = 31 at unknown) .
  3. There is no clear difference in death rates when measured alone.
Pepine et al: Clinical Cardiology 1998; 21: 633-641
Expires March 2003

The study

Systematic review of prospectively randomised, controlled trials of
  • Patients: acute myocardial infarction, angina or hypertension
  • Intervention: verapamil compared with placebo
  • Outcome: mortality, nonfatal infarction or reinfarction and a combination of these


    • Articles found in English using MEDLINE, 1966 to April 1997 (search terms: verapamil alone, and coupled with clinical trial, MI, angina and hypertension ) and references of relevant articles were searched. Handsearch of review papers, Science Citation Index and Current Contents.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: no details given

    Seven trials were included.
    • Dose of verapamil ranged from 240-360 mg per day (mainly 120 mg three times a day), and duration ranged from 48 hours to 24 months. Treatment was initiated anywhere between admission and 21 days post MI.

    The evidence

    Outcome Time to outcome CER RR
    (95% CI)    		 NNT
    (95% CI)
    nonfatal reinfarction unknown 347/4662
    (7.44%)    		 0.79
    (0.65 to 0.97)     		64
    (38 to 448)
    nonfatal reinfarction and death combined unknown 847/4662
    (18.2%)    		 0.82
    (0.70 to 0.92)     		31
    (18 to 69)
    death unknown 500/4662
    (10.7%)    		 0.93
    (0.78 to 1.10)     		134
    (NNT = 42 to infinity;
    NNH = 93 to infinity)

    • Relative risk for mortality ranged from 0.93 to 0.86 depending on the rules used to include or exclude patients.

    Comments

    1. Calcium channel antagonists are a heterogeneous class of drugs, and these results may not be applicable across the whole spectrum.

    Citation

    1. Pepine CJ, Faich G, Makuch R: Verapamil use in patients with cardiovascular disease: An overview of randomized trials. Clinical Cardiology 1998; 21: 633-641
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer: William Rhoton

    Clinical Question.
    Patient cardiovascular disease
    Intervention or Exposure verapamil
    Comparison placebo
    Outcome mortality