VERAPAMIL TREATMENT AFTER CORONARY ANGIOPLASTY IN PATIENTS AT HIGH-RISK OF RECURRENT STENOSIS

Objective-To evaluate the efficacy of high-dose verapamil treatment (2 40 mg twice daily) in the prevention of angiographic restenosis after primary successful coronary angioplasty in patients at high risk of re current obstruction. Design-A placebo controlled, double blind trial i n which patients with stable angina pectoris and patients with unstabl e angina or non-Q wave infarction treated with 330 mg aspirin and 75 m g dipyridamole twice daily were randomised to a verapamil group or a c ontrol group. Follow up angiography was performed 6 months after angio plasty or sooner if signs of recurrent ischaemia developed. Setting-Un iversity department of cardiology. Patients-196 consecutive patients u ndergoing coronary angioplasty from the beginning of April 1987 to the end of March 1989 and meeting the selection criteria that included th e presence of at least one of six predefined risk factors for restenos is. lit the time of coronary angioplasty 113 patients had unstable ang ina or non-Q wave infarction and 83 had stable angina pectoris. Result s-In 89 (91%) patients in the verapamil group and in 83 (85%) control patients follow up angiograms were available. The restenosis rate was lower in the verapamil group (48.3%) than in the placebo group (62.7%) (odds ratio 0.56, 95% confidence interval (CI) 0.303 to 1.025 p = 0.0 59). Of the 172 patients in whom follow up angiograms were avail able, 24 (13 taking verapamil and 11 taking placebo) did not comply with th e trial for more than 40 (34) days (mean (1 SD)). For the remaining 14 8 patients the restenosis rate was 47.4% in the verapamil group and 63 .9% in the placebo group (odds ratio 0.52, 95% CI 0.271 to 0.993, p = 0.046). In the 97 patients with unstable angina or non-Q wave infarcti on the restenosis rate was not significantly influenced by verapamil ( 55.8% with verapamil v 62.2% with placebo, odds ratio 0.77, 95% CI 0.3 39 to 1.728, p = 0.520). In the 75 patients with stable angina pectori s the restenosis rate dropped from 63.2% with placebo to 37.8% with ve rapamil (odds ratio 0.36, 95% CI 0.137 to 0.917, p = 0.038). Conclusio n-The observed beneficial effect of high-dose verapamil treatment on t he angiographic restenosis rate in patients with stable angina pectori s and at increased risk of recurrent obstruction requires confirmation in further prospective studies.