INFLUENCE OF AGE AND EFFECT OF VERAPAMIL ON MAJOR EVENTS IN PATIENTS RECOVERING FROM ACUTE MYOCARDIAL-INFARCTION

Background: We set out to describe the prognosis of acute myocardial i nfarction and the effect of postinfarction intervention with verapamil on prognosis in relation to age. Methods: The study included 1775 con secutively admitted patients who had acute myocardial infarction and n o contraindications to treatment with verapamil. During the second wee k after infarction, patients were double-blindly randomly assigned to placebo (n=897) or verapamil treatment (n=878) and followed up for 18 months (mean 16 months). The endpoint was the first major event (death or reinfarction). Results: The number of patients with one or more ma jor risk factors increased significantly with increasing age (P<0.0000 1); age was a significant predictor of major events (P=0.00003). In a multivariate analysis including all variables that after univariate an alysis correlated significantly with major events, age was stilt a sig nificant risk predictor. In all patients, intervention with verapamil significantly reduced the number of major events (P=0.03, hazard ratio 0.80). Overall, a strong trend towards an increasing effect of verapa mil with increasing age was found (P=0.08). In younger patients (<51 y ears), no effect of verapamil was found (hazard ratio 1.10). In middle -aged patients (51-65 years), verapamil reduced the number of major ev ents by 14.1% (hazard ratio 0.82), and in elderly patients (>65 years) by 24.7% (hazard ratio 0.74, P=0.09). Conclusion: The risk of major e vents increases significantly with increasing age, and the effect of s econdary prevention with verapamil increases with increasing age, alth ough this association is of only borderline significance.