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Calcium channel blockers in acute myocardial infarction and unstable angina: an overview
P H Held1, S Yusuf, C D Furberg
1Division of Epidemiology and Clinical Applications, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892.
Insights
Calcium channel blockers (CCBs) did not reduce the risk of heart attack, reinfarction, or death in patients with acute myocardial infarction or unstable angina. This systematic overview found no evidence of benefit from routine CCB use in these cardiac conditions.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Calcium channel blockers (CCBs) are a class of drugs used to manage various cardiovascular conditions.
- Their role in acute myocardial infarction (AMI) and unstable angina (UA) requires clear understanding of their efficacy and safety.
Purpose of the Study:
- To systematically evaluate the impact of calcium channel blockers on infarct development, reinfarction rates, and overall mortality.
- To assess the effectiveness of CCBs in patients diagnosed with acute myocardial infarction or unstable angina.
Main Methods:
- A comprehensive systematic overview was conducted, analyzing all available randomized trials.
- Data from 28 randomized trials involving approximately 19,000 patients were included.
- The analysis focused on trials concerning calcium channel blockers in the context of myocardial infarction and unstable angina.
Main Results:
- In myocardial infarction trials, no significant difference in mortality was observed between CCB treatment and control groups (OR 1.06, 95% CI 0.96-1.18).
- Calcium channel blockers showed no beneficial effect on infarct size or the rate of reinfarction.
- Similar outcomes were noted in trials for unstable angina, with no reduction in myocardial infarction or death rates.
Conclusions:
- Routine administration of calcium channel blockers does not appear to lower the risk of initial or recurrent infarction in patients with AMI or UA.
- These findings suggest that CCBs do not provide a mortality benefit when used broadly in these patient populations.
Objective:
To assess the effects of calcium channel blockers on development of infarcts, reinfarction, and mortality.
Design:
A systematic overview of all randomised trials of calcium channel blockers in myocardial infarction and unstable angina.
Patients:
19,000 Patients in 28 randomised trials.
Results:
In the trials of myocardial infarction 873 deaths occurred among 8870 patients randomised to active treatment compared with 825 deaths among 8889 control patients (odds ratio of 1.06, 95% confidence interval of 0.96 to 1.18). There was no evidence of a beneficial effect on development and size of infarcts or rate of reinfarction. The results were similar in short term trials in which treatment was confined to the acute phase and those in which treatment was started some weeks later and continued for a year or two. There was no evidence of heterogeneity among different calcium channel blockers in their effects on any end point. The results were similar in the unstable angina trials (110 out of 561 patients treated with calcium channel blocker compared with 104 out of 548 controls developed a myocardial infarction; 14 out of 591 treated compared with nine out of 578 controls died).
Conclusions:
Calcium channel blockers do not reduce the risk of initial or recurrent infarction or death when given routinely to patients with acute myocardial infarction or unstable angina.