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Effect of verapamil on mortality and major events after acute myocardial infarction (The Danish Verapamil Infarction Trial II — DAVIT II)

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      Abstract

      The effect of verapamil on death and major events (i.e., death or reinfarction) after an acute myocardial infarction was studied in a double-blind, randomized, placebo-controlled multicenter trial. Eight hundred seventy-eight patients started treatment with verapamil, 360 mg/day, and 897 patients with placebo. Treatment started in the second week after admission and continued for up to 18 months (mean 16 months). Ninety-five deaths and 146 major events occurred in the verapamil group and 119 deaths and 180 major events in the placebo group. The 18-month mortality rates were 11.1 and 13.8% (p = 0.11, hazard ratio, 0.80; 95% confidence limits, 0.61 to 1.05), and major event rates 18.0 and 21.6% (p = 0.03, hazard ratio, 0.80; 95% confidence limits, 0.64 to 0.99) in the verapamil and placebo groups, respectively. In patients without heart failure in the coronary care unit the mortality rates were 7.7% in the verapamil group and 11.8% in the placebo group (p = 0.02, hazard ratio, 0.64; 95% confidence limits, 0.44 to 0.94), and major event rates 14.6 and 19.7% (p = 0.01, hazard ratio 0.70; 95% confidence limits (0.52 to 0.93). In patients with heart failure the mortality rates were 17.9 and 17.5% (p = 0.79, hazard ratio, 1.05; 95% confidence limits, 0.72 to 1.54), and major event rates 24.9 and 24.9% (p = 1.0, hazard ratio 0.98; 95% confidence limits 0.72 to 1.39).
      Long-term treatment with verapamil after an acute myocardial infarction caused a significant reduction in major events, and the positive effect was found in patients without heart failure.
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      References

        • Nayler WG
        Calcium antagonists and the ischemic myocardium.
        Int J Cardiol. 1987; 15: 267-285
        • Kloner RA
        • Braunwald E
        Effects of calcium antagonists on infarcting myocardium.
        Am J Cardiol. 1987; 59: 84B-94B
        • Skolnick AE
        • Frishman WH
        Calcium channel blockers in myocardial infarction.
        Arch Intern Med. 1989; 149: 1669-1677
        • Hansen JF
        • Sigurd B
        • Mellemgaard K
        • Lyngbye J
        Verapamil in acute myocardial infarction.
        Dan Med Bull. 1980; 27: 105-109
        • The Danish Study Group on Verapamil in Myocardial Infarction
        Verapamil in acute myocardial infarction.
        Eur Heart J. 1984; 5: 516-528
        • The Danish Study Group on Verapamil in Myocardial Infarction
        Verapamil in acute myocardial infarction.
        Am J Cardiol. 1984; 54: 24E-28E
        • The Danish Study Group on Verapamil in Myocardial Infarction
        The Danish studies on verapamil in myocardial infarction.
        Br J Clin Pharmacol. 1986; 21: 197S-204S
        • Reimer KA
        • Jennings RB
        Verapamil in two reperfusion models of myocardial infarction.
        Lab Invest. 1984; 51: 655-666
        • Yellon DM
        • Hearse J
        • Maxwell MP
        • Chambers DE
        • Downey JM
        Sustained limitation of myocardial necrosis 24 hours after coronary artery occlusion: verapamil infusion in dogs with small myocardial infarcts.
        Am J Cardiol. 1983; 51: 1409-1413
        • Przyklenk K
        • Kloner RA
        Effect of verapamil on postischemic “stunned” myocardium. Importance of the timing of treatment.
        J Am Coll Cardiol. 1988; 11: 614-623
        • Subramanian VB
        • Bowles ML
        • Lahiri A
        • Davies AB
        • Raftery EB
        Long-term antianginal action of verapamil assessed with quantitated serial treadmill stress testing.
        Am J Cardiol. 1981; 48: 529-535
        • Mauritson DR
        • Johnson SM
        • Winniford MD
        • Gary JR
        • Willerson JT
        • Hillis LD
        Verapamil for unstable angina at rest. A short-termed randomized, double blind study.
        Am Heart J. 1983; 106: 652-658
        • Mauri F
        • Mafrici A
        • Biraghi M
        • Cerri P
        • De Biase AM
        Effectiveness of calcium antagonist drugs in patients with unstable angina and proven coronary artery disease.
        Eur Heart J. 1988; 9: 158-163
        • Johnson SM
        • Mauritson DR
        • Willerson JT
        • Hillis LD
        A controlled trial of verapamil for Prinzmetal's variant angina.
        N Engl J Med. 1981; 304: 862-866
        • Parodi O
        • Simonetti I
        • Michelassi C
        • Carpeggiani C
        • Biagini A
        • L'Abbate A
        • Maseri A
        Comparison of verapamil and propranolol therapy for angina at rest: a randomized, multiple crossover, controlled trial in the coronary care unit.
        Am J Cardiol. 1986; 57: 899-906
        • Woelfel A
        • Foster JR
        • McAllister RG
        • Simpson RJ
        • Gettes LS
        Efficacy of verapamil in exercise-induced ventricular tachycardia.
        Am J Cardiol. 1985; 56: 292-297
        • Gülker H
        • Godejohann U
        • Dorsel T
        • Behrenbeck T
        • Heuer H
        • Bender F
        Prophylaxe belastungsinduzierter ventrikulärer Arrhythmien durch Verapamil.
        Z Kardiol. 1987; 76: 404-410
        • The Multicenter Diltiazem Postinfarction Trial Research Group
        The effect of diltiazem on mortality and reinfarction after myocardial infarction.
        N Engl J Med. 1988; 319: 385-392
        • The Israeli Sprint Study Group
        Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT). A randomized intervention trial of nifedipine in patients with acute myocardial infarction.
        Eur Heart J. 1988; 9: 354-364
        • Packer M
        Combined beta-adrenergic and calcium-entry blockade in angina pectoris.
        N Engl J Med. 1989; 320: 709-718
        • Held PH
        • Yusuf S
        • Furberg CD
        Calcium channel blockers in acute myocardial infarction and unstable angina: an overview.
        Br Med J. 1989; 299: 1187-1192
        • SPRINT Study Group
        The Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT) II: design and methods: results (abstr).
        Eur Heart J. 1988; 9: 350
        • deGeest H
        • Kesteloot H
        • Piessens J
        Secondary prevention of ischaemic heart disease: a long-term controlled lidoflazine study.
        Acta Cardiol. 1979; 34: 7-50
        • Yusuf S
        • Wittes J
        • Friedman L
        Overview of results of randomized clinical trials in heart disease. I. Treatments following myocardial infarction.
        JAMA. 1988; : 2088-2093