Myocardial infarction: verapamil and diltiazem decrease reinfarction.

Clinical bottom line (level 1a)

  1. Patients with a myocardial infarction or stable angina who are given verapamil or diltiazem are less likely to have a reinfarction than those given a control (NNT = 68 at unknown) .
  2. Neither verapamil or diltiazem has an effect on mortality.
  3. Nifedipine/nicardipine had a strong trend to increased mortality.
Yusuf et al: American Journal of Cardiology 1991; 67: 1295-1297
Expires December 2003

The study

Systematic review of randomised controlled trials of
  • Patients: myocardial infarction or stable angina
  • Intervention: calcium antagonists (verapamil, diltiazem) or calcium channel blockers (nifedipine) compared with control
  • Outcome: death, reinfarction


    • Articles found in ? using ?, ? (search terms: not given )

    Selection criteria: not given
    Appraisal criteria: not given
    Articles excluded if:

    Four trials were included. Three comparing dihydropyridine calcium blockers with controls, and two comparing calcium antagonists that slow the heart rate with controls (one trial in both).

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    verapamil, diltiazem: reinfarction unknown 313/4184
    (7.5%)    		 0.79
    (0.67 to 0.94)     		68
    (43 to 240)
    verapamil, diltiazem: mortality unknown 447/4226
    (10.6%)    		 0.95
    (0.82 to 1.09)     		210
    (NNT = 58 to infinity;
    NNH = 120 to infinity)
    nifedipine/nicardipine (mortality) unknown 335/5135
    (6.5%)    		 1.16
    (0.99 to 1.35)     		-92
    (NNT = 43 to infinity;
    NNH = 1458 to infinity)

    Comments

    1. The searching and selection criteria were not given in this paper as it was an update of a previous systematic review, where the details were described.

    Citation

    1. Yusuf S, Held P, Furberg C: Update of effects of calcium antagonists in myocardial infarction or angina in light of the second Danish Verapamil Infarction Trial II (DAVIT-II) and other recent studies. American Journal of Cardiology 1991; 67: 1295-1297
    Contributor: Clare Wotton and Bob Phillips, December 2000
    Reviewer:

    Clinical Question.
    Patient myocardial infarction
    Intervention or Exposure calcium antagonists or calcium channel blockers
    Comparison control
    Outcome death, reinfarction