CALCIUM-ANTAGONISTS IN THE SECONDARY PREV ENTION OF MYOCARDIAL-INFARCTION

We performed a meta-analysis on data from trials of calcium antagonist drugs in the secondary prevention of myocardial infarction. Nifedipin e (9 033 patients) increased total mortality non significantly by 12 % at the end of follow-up, and by 62 % (p = 0.02) before 21 days, with no significant change in the risk of reinfarction. Diltiazem or verapa mil did not change total mortality significantly;each of them decrease d the risk of reinfarction not significantly (p = 0.06) by approximate ly 20 %. Treatment by either diltiazem or verapamil (8 356 patients) d ecreased the risk of reinfarction by 21 % (p = 0.009). No benefit has been demonstrated with nifedipine in the secondary prevention of myoca rdial infarction. Verapamil or diltiazem may be an alternative to beta -blockers when these last drugs are contra-indicated, although one can not reasonably expect from the first two drugs a decrease in mortality .