Ferrari R, Visioli O
Cattedra di Cardiologia, Università degli Studi di Brescia, Italy.
Drugs. 1991;42 Suppl 1:14-26; discussion 26-7. doi: 10.2165/00003495-199100421-00005.
The most positive results in this area have been those of the second Danish Study Group on Verapamil in Myocardial Infarction (1990) which assessed the benefit of treatment with verapamil from the second week after myocardial infarction. Verapamil produced a significant reduction in both mortality and reinfarction rates. Consequently, it may be concluded that treatment with calcium antagonists, such as verapamil and diltiazem, should not be used in the acute phase of myocardial infarction, but rather as prophylaxis to prevent reinfarction by protecting against myocardial ischaemia. The lack of reported cardioprotective efficacy with calcium antagonists, which contrasts with experimental predictions, can be explained by the inappropriate timing of administration and the use of dihydropyridine, which can be detrimental in myocardial infarction. These is little or no evidence to show that calcium antagonists are cardioprotective in patients with myocardial infarction or unstable angina. Thus, the randomised trials studying acute myocardial infarction reveal no overall effect of treatment on mortality in the short or long term. The prototype calcium antagonists differ in their effects on the reinfarction rate in these patients. With verapamil there is a small tendency for a reduction in reinfarction, with nifedipine a clear worsening, and with diltiazem a reduction almost reaching statistical significance. The general lack of protective efficacy is presumably a result of the drugs being administered too late after the onset of ischaemia.
该领域最积极的成果来自丹麦第二个维拉帕米治疗心肌梗死研究小组（1990年），该小组评估了心肌梗死后第二周开始使用维拉帕米治疗的益处。维拉帕米显著降低了死亡率和再梗死率。因此，可以得出结论，钙拮抗剂如维拉帕米和地尔硫䓬在心肌梗死急性期不应使用，而应用于预防再梗死，通过预防心肌缺血来实现。与实验预测相反，钙拮抗剂未报告有心脏保护作用，这可以通过给药时机不当以及使用二氢吡啶来解释，二氢吡啶在心肌梗死中可能有害。几乎没有证据表明钙拮抗剂对心肌梗死或不稳定型心绞痛患者有心脏保护作用。因此，研究急性心肌梗死的随机试验显示，治疗对短期或长期死亡率没有总体影响。原型钙拮抗剂对这些患者的再梗死率有不同影响。使用维拉帕米时再梗死有轻微降低趋势，使用硝苯地平则明显恶化，使用地尔硫䓬时降低几乎达到统计学意义。普遍缺乏保护作用可能是由于在缺血发作后给药太晚。
