Jespersen C M
Department of Cardiovascular Medicine Y, Bispebjerg Hospital, Copenhagen, Denmark.
Cardiovasc Drugs Ther. 1999 Jul;13(4):301-7. doi: 10.1023/a:1007751231224.
Verapamil is well tolerated in patients with stable and unstable angina pectoris, as well as in patients with threatened infarction. No data exist documenting verapamil to be inferior to beta-blockers in these stages of coronary heart diseases. In the prethrombolytic era i.v. intervention with verapamil did not add any benefit in the early phase of AMI. However, a retrospective analysis suggests the hypothesis that i.v. verapamil given in combination with thrombolysis may improve the prognosis, and an ongoing study (VAMI trial) examines this hypothesis. When given in the late in-hospital phase of AMI to patients without heart failure verapamil significantly reduces mortality and morbidity. When given in the late in-hospital phase to patients with heart failure verapamil did not cause the course or prognosis to deteriorate and might even improve it in patients with residual ischaemia, especially when given in combination with an ACE-inhibitors. A planned study (DAVIT III study) has to confirm these preliminary data.
维拉帕米在稳定型和不稳定型心绞痛患者以及有梗死风险的患者中耐受性良好。尚无数据表明在冠心病的这些阶段维拉帕米比β受体阻滞剂差。在溶栓前时代，静脉注射维拉帕米在急性心肌梗死早期并未带来任何益处。然而，一项回顾性分析提出了静脉注射维拉帕米联合溶栓可能改善预后的假设，一项正在进行的研究（VAMI试验）正在检验这一假设。当在急性心肌梗死的住院后期给予无心力衰竭的患者时，维拉帕米可显著降低死亡率和发病率。当在住院后期给予心力衰竭患者时，维拉帕米不会使病情或预后恶化，甚至可能改善有残余缺血的患者的病情，尤其是与血管紧张素转换酶抑制剂联合使用时。一项计划中的研究（DAVIT III研究）必须证实这些初步数据。
