Circulation, Vol 69, 740-747, Copyright © 1984 by American Heart Association
JE Muller, J Morrison, PH Stone, RE Rude, B Rosner, R Roberts, DL Pearle, ZG Turi, JF Schneider and DH Serfas
Preliminary clinical and laboratory observations suggest that nifedipine
might prevent progression of threatened myocardial infarction by reversing
coronary spasm or might limit necrosis during the course of acute
myocardial infarction. We screened 3143 patients with ischemic pain of
greater than 45 min duration and randomly assigned 105 eligible patients
with threatened myocardial infarction and 66 with acute myocardial
infarction to receive nifedipine (20 mg orally every 4 hr for 14 days) or
placebo plus standard care. Treatment was started 4.6 +/- 0.1 hr after the
onset of pain. Infarct size index was calculated by the MB-creatine kinase
(CK) method and expressed as CK-geq/m2 +/- SE. The incidence of progression
to infarction among patients with threatened myocardial infarction was not
significantly altered by nifedipine (36 of 48 [75%] for placebo-treated and
43 of 57 [75%] for nifedipine-treated patients). Furthermore, infarct size
index was similar among placebo- and nifedipine-treated patients (16.9 +/-
1.5 MB-CK-geq/m2, n = 65, and 17.0 +/- 1.5 MB-CK-geq/m2, n = 68,
respectively) with threatened myocardial infarction who exhibited
infarction and for those with acute myocardial infarction. Among the 171
eligible patients randomly assigned to drug or placebo, 6 month mortality
did not differ significantly (8.5% for placebo vs 10.1% for nifedipine,
NS), but mortality in the 2 weeks after randomization was significantly
higher for nifedipine-treated patients (0% for placebo compared with 7.9%
for nifedipine, p = .018).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Nifedipine therapy for patients with threatened and acute myocardial infarction: a randomized, double-blind, placebo-controlled comparison
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