ANTIISCHEMIC INTERVENTION WITH VERAPAMIL IN PATIENTS RECOVERING FROM ACUTE MYOCARDIAL-INFARCTION

The present review discusses the prognostic significance of post-infar ction angina pectoris, and the significance of postinfarction interven tion with verapamil on the prevalence of post-infarction ischaemia and prognosis. Angina pectoris during the first month after acute myocard ial infarction (AMI) was found to be a significant predictor of subseq uent major events (death and reinfarction) (P = 0.03). The prognosis i n patients with postinfarction angina pectoris was as poor as that obs erved in patients with mild to moderate congestive heart failure. Inte rvention with verapamil significantly reduced the 1 month prevalence o f angina pectoris (P = 0.02), and thereby also the number of patients at high risk. In patients with ST-segment depression provoked during a pie-discharge, post-infarction exercise test, intervention with verap amil reduced major events by 41% compared with placebo. In patients wi th both heart failure and angina pectoris, anti-ischaemic intervention with verapamil reduced the 17 month event late by 37%, whereas no eff ect was found in patients with heart failure, but no angina pectolis. We conclude that angina pectoris following AMI is a significant risk p redictor in both patients with and without impaired cardiac function. Intervention with verapamil significantly reduces post-infarction isch aemia, thereby reducing the risk of reinfarction and death.