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Current status of calcium channel-blocking drugs after Q wave and non-Q wave myocardial infarction
1Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
Insights
Calcium channel blockers are used for cardiovascular disorders. Diltiazem shows benefits in acute myocardial infarction patients, especially those with non-Q wave infarction and normal left ventricular function.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Calcium channel blockers (CCBs) possess anti-ischemic and spasmolytic properties.
- Their cardioprotective effects are investigated in acute myocardial infarction (AMI).
Purpose of the Study:
- To review the application of CCBs in limiting infarct size, reducing mortality, and incident morbidity in AMI.
- To evaluate the efficacy of specific CCBs like nifedipine, verapamil, and diltiazem in AMI.
Main Methods:
- Review of clinical trials and existing literature on CCB use in acute myocardial infarction.
- Analysis of data regarding infarct size limitation, mortality rates, and morbidity events.
Main Results:
- Nifedipine demonstrated no beneficial effects and potential harm in AMI.
- Verapamil showed no preventive effect on death, reinfarction, or postinfarction angina.
- Diltiazem is the only CCB with proven short- and long-term clinical benefits in AMI, particularly in patients with non-Q wave infarction and normal left ventricular function.
Conclusions:
- Diltiazem offers significant clinical benefits in acute myocardial infarction, contingent on appropriate patient selection.
- CCBs like verapamil and diltiazem may limit infarct size, but further research is needed.
- Nifedipine is not recommended for use in acute myocardial infarction.
Abstract:
The calcium channel blockers are useful in treating many cardiovascular disorders. Due to their anti-ischemic and spasmolytic properties, the cardioprotective effects of these agents have been studied in the setting of acute myocardial infarction. This paper will review this application with respect to limitation of infarct size, reduction of mortality, and incident morbidity rates. Of the agents currently available for clinical use, nifedipine has been studied most extensively. This agent shows no beneficial effects and its use can, in fact, be harmful in this setting. Of the few trials that have been conducted with verapamil, none have shown a preventive effect on death, reinfarction, or postinfarction angina. Both verapamil and diltiazem might limit infarct size although further confirmation is required. At the present time, diltiazem is the only agent shown to have short- and long-term benefits on clinical outcome in patients with acute myocardial infarction. The success of prophylactic diltiazem is, however, critically dependent on proper patient selection. In particular, those patients with non-Q wave infarction, normal left ventricular function, or both can be expected to derive the greatest benefit in terms of reduced mortality and incident morbidity.