Held P H, Yusuf S, Furberg C D
Division of Epidemiology and Clinical Applications, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892.
BMJ. 1989 Nov 11;299(6709):1187-92. doi: 10.1136/bmj.299.6709.1187.
To assess the effects of calcium channel blockers on development of infarcts, reinfarction, and mortality.
A systematic overview of all randomised trials of calcium channel blockers in myocardial infarction and unstable angina.
19,000 Patients in 28 randomised trials.
In the trials of myocardial infarction 873 deaths occurred among 8870 patients randomised to active treatment compared with 825 deaths among 8889 control patients (odds ratio of 1.06, 95% confidence interval of 0.96 to 1.18). There was no evidence of a beneficial effect on development and size of infarcts or rate of reinfarction. The results were similar in short term trials in which treatment was confined to the acute phase and those in which treatment was started some weeks later and continued for a year or two. There was no evidence of heterogeneity among different calcium channel blockers in their effects on any end point. The results were similar in the unstable angina trials (110 out of 561 patients treated with calcium channel blocker compared with 104 out of 548 controls developed a myocardial infarction; 14 out of 591 treated compared with nine out of 578 controls died).
Calcium channel blockers do not reduce the risk of initial or recurrent infarction or death when given routinely to patients with acute myocardial infarction or unstable angina.
评估钙通道阻滞剂对梗死形成、再梗死及死亡率的影响。
对钙通道阻滞剂用于心肌梗死和不稳定型心绞痛的所有随机试验进行系统综述。
28项随机试验中的19000名患者。
在心肌梗死试验中，随机接受积极治疗的8870名患者中有873人死亡，而8889名对照患者中有825人死亡（比值比为1.06，95%置信区间为0.96至1.18）。没有证据表明其对梗死的形成和大小或再梗死率有有益影响。在治疗限于急性期的短期试验以及治疗在数周后开始并持续一两年的试验中，结果相似。没有证据表明不同钙通道阻滞剂在对任何终点的影响方面存在异质性。在不稳定型心绞痛试验中结果相似（接受钙通道阻滞剂治疗的561名患者中有110人发生心肌梗死，而548名对照中有104人发生；接受治疗的591名患者中有14人死亡，而578名对照中有9人死亡）。
对于急性心肌梗死或不稳定型心绞痛患者，常规给予钙通道阻滞剂并不能降低初始或复发性梗死或死亡的风险。
