Calcium-channel blockers as adjuvant therapy postthrombolysis.

Following successful thrombolytic therapy for evolving acute myocardial infarction, the inevitable process of transmural necrosis is favorably altered in a majority of patients, resulting in an aborted, or interrupted, myocardial infarction. Presumably, such myocardial salvage results in an "incomplete" infarction, which is often associated with a patent (but residually stenotic) infarct-related coronary artery. In this regard, the acute myocardial infarction successfully reperfused with thrombolytic therapy resembles non-Q-wave infarction. The subsequent pharmacologic therapy of the "incomplete" infarction remains ill-defined. This article reviews the features which "naturally occurring" non-Q-wave infarction shares with the successfully reperfused myocardial infarction. In addition, the role of adjunctive pharmacologic therapy with calcium-channel-blocker therapy is addressed; in particular, the results of the Diltiazem Reinfarction Study and the non-Q-wave infraction subset analysis of the Multicenter Diltiazem Post-Infarction Trial are discussed to provide the conceptual basis for considering such treatment appropriate adjunctive pharmacologic therapy for the postthrombolysis patient.