SHORT-ACTING NIFEDIPINE AND DILTIAZEM DO NOT REDUCE THE INCIDENCE OF CARDIAC EVENTS IN PATIENTS WITH HEALED MYOCARDIAL-INFARCTION

Background The administration of calcium antagonists to patients with healed myocardial infarction is a controversial treatment. This study was conducted to elucidate the effect of short-acting nifedipine and d iltiazem on cardiac events in patients with healed myocardial infarcti on. Methods and Results A controlled clinical open trial of 1115 patie nts with healed myocardial infarction was carried out between 1986 and 1994. The patients included 595 who received no calcium antagonist, 3 41 who received short-acting nifedipine 30 mg/d, and 179 who received short-acting diltiazem 90 mg/d. The primary end points were cardiac ev ents, which were defined as fatal or nonfatal recurrent myocardial inf arction; death from congestive heart failure; sudden death; and hospit alization because of worsening angina, congestive heart failure, or pr emature ventricular contractions. Cardiac events occurred in 51 patien ts (8.6%) in the no-calcium-antagonist group and 54 (10.4%) in the cal cium-antagonist group (odds ratio, 1.24; 95% CI, 0.83 to 1.85), demons trating that the calcium antagonists did not reduce the incidence of c ardiac events. Subgroup analysis revealed no beneficial effects of the se drugs for reducing cardiac events in patients with such complicatio ns as hypertension or angina pectoris.Conclusions This study showed th at use of short-acting nifedipine and diltiazem in this postmyocardial infarction population was associated with a 24% higher cardiac event rate, but this strong adverse trend did not reach statistical signific ance.