Hansen J F
Department of Cardiology, Hvidovre University Hospital, Denmark.
Drugs. 1992;44 Suppl 1:33-43. doi: 10.2165/00003495-199200441-00007.
Experimental studies have demonstrated that the 3 calcium antagonists nifedipine, diltiazem, and verapamil have a comparable effect in the prevention of myocardial damage during ischaemia. Secondary prevention trials after acute myocardial infarction, which aimed at improving survival and preventing reinfarction, nevertheless demonstrated pronounced differences between the 3 drugs. Nifedipine had no effect on reinfarction or death. Diltiazem had no overall effect but prevented first reinfarction or cardiac death (cardiac events) in patients without heart failure, and increased cardiac events in patients with heart failure before randomisation. Verapamil prevented first reinfarction or death (major events); the most pronounced effect was found in patients without heart failure before randomisation. Verapamil did not have detrimental effects in patients treated for heart failure before randomisation. Differences between trials and between drugs explaining the different clinical findings are evaluated.
实验研究表明，硝苯地平、地尔硫䓬和维拉帕米这三种钙拮抗剂在预防缺血期间的心肌损伤方面具有相似的效果。然而，急性心肌梗死后旨在提高生存率和预防再梗死的二级预防试验显示，这三种药物之间存在显著差异。硝苯地平对再梗死或死亡没有影响。地尔硫䓬总体上没有效果，但可预防无心力衰竭患者的首次再梗死或心源性死亡（心脏事件），并增加随机分组前有心力衰竭患者的心脏事件。维拉帕米可预防首次再梗死或死亡（重大事件）；在随机分组前无心力衰竭的患者中发现最显著的效果。维拉帕米对随机分组前接受心力衰竭治疗的患者没有有害影响。评估了解释不同临床结果的试验之间和药物之间的差异。
