LONG-TERM FOLLOW-UP AFTER EARLY INTERVENTION WITH INTRAVENOUS DILTIAZEM OR INTRAVENOUS NITROGLYCERIN FOR UNSTABLE ANGINA-PECTORIS

Aims In a double-blind randomized trial in unstable angina it was show n that intravenous diltiazem reduced ischaemic events in the first 48 h after inclusion better than intravenous nitroglycerin. The present s tudy was performed to establish the long-term prognosis of the randomi zed patients, with respect to their initial treatment assignment. Meth ods and Results One year follow-up data on ischaemic end-points and an ti-ischaemic medication were recorded. Results were available for all of the 121 randomized patients. One hundred and sixty-seven primary en dpoint events were recorded, of which 54 occurred in the first 48 h an d 113 during the follow-up. Survival analysis showed that event-free s urvival was significantly better in the diltiazem group (45.0%) than i n the nitroglycerin group (34.4%), P=0.04. The incidence rate after 48 h and one year for cardiac death are, respectively, 0% and 4.1%. The trend in anti-ischaemic medication was higher in the nitroglycerin gro up. For beta-blockers, this trend became significant after 12 months ( P=0.03). Conclusion These results show that the initial benefit obtain ed by early treatment with intravenous diltiazem was preserved during the first year after the initial hospitalization, and that, despite th e high risk of cardiac events in our population, the overall mortality 12 months after inclusion was low.