Lièvre M, Boissel J P
Unité de pharmacologie clinique, Lyon.
Arch Mal Coeur Vaiss. 1993 Jul;86 Spec No 4:91-8.
Many theoretical and experimental studies suggest that calcium antagonists drugs should be useful in pathological situations of myocardial ischemia or ischemia/reperfusion. This therapeutic model was tested in controlled trials of angina, post-infarction and cardiac surgery. The authors undertook a meta-analysis of these trials using the occurrence of myocardial infarction or death as criteria of judgement. No long-term benefits seem to be associated with the dihydropyridines such as nifedipine and nicardipine in anginal patients. In unstable angina, betablockers seem to be more effective but the difference is not statistically significant. In the post-infarction period, nifedipine does not reduce the risk of recurrence of myocardial infarction and may even increase the mortality by 15%, though this was not significant in the 9,055 patients studied (p = 0.08). Verapamil and diltiazem globally reduce the risk of recurrent infarction by 21% (p = 0.009) but not mortality (p = 0.52). Because of the small numbers of patients and the low prevalence of observed events, no useful conclusions can be drawn from studies of calcium antagonists in cardiac surgery. The results of the validation of the therapeutic model "calcium antagonists in pathological situation of myocardial ischemia or ischemia/reperfusion" does not justify the labels "anti-ischemics" or "cardio protectors" often applied to the calcium antagonists.
许多理论和实验研究表明，钙拮抗剂药物在心肌缺血或缺血/再灌注的病理情况下应具有疗效。这种治疗模式在心绞痛、心肌梗死后和心脏手术的对照试验中得到了验证。作者以心肌梗死或死亡的发生率作为判断标准，对这些试验进行了荟萃分析。对于心绞痛患者，硝苯地平和尼卡地平等二氢吡啶类药物似乎没有长期益处。在不稳定型心绞痛中，β受体阻滞剂似乎更有效，但差异无统计学意义。在心肌梗死后阶段，硝苯地平并不能降低心肌梗死复发的风险，甚至可能使死亡率增加15%，尽管在9055例研究患者中这一差异并不显著（p = 0.08）。维拉帕米和地尔硫䓬总体上使复发梗死风险降低了21%（p = 0.009），但对死亡率没有影响（p = 0.52）。由于心脏手术研究中的患者数量较少且观察到的事件发生率较低，关于钙拮抗剂的研究无法得出有用的结论。“心肌缺血或缺血/再灌注病理情况下的钙拮抗剂”这一治疗模式的验证结果并不能证明钙拮抗剂常被贴上的“抗缺血药”或“心脏保护剂”标签是合理的。
