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NIFEDIPINE MAY INCREASE MORTALITY IN ACUTE MI.

Trials of calcium channel blockers given during or just after acute myocardial infarction generally have not shown reductions in mortality, and there is some evidence that these drugs can be hazardous. This multicenter Israeli study found that post-MI mortality may be higher after administration of nifedipine.

Nifedipine (60 mg per day) or placebo was given to 1358 patients with suspected acute MI as soon as possible after hospital admission. The drug was discontinued within several days in 352 patients, usually because MI was ruled out or because patients were not considered to be at high risk. The remaining 1006 patients had confirmed acute MI and continued taking nifedipine or placebo for up to 6 months. Among patients who continued treatment, the 6-month mortality rate was 18.7 percent with nifedipine versus 15.6 percent with placebo, a difference of borderline statistical significance. Most excess deaths among nifedipine users occurred during the first 6 days of hospitalization.

These data suggest that nifedipine may promote early death after acute MI. A few studies have shown that certain drugs may benefit certain subgroups (e.g., diltiazem in non-Q-wave infarction), but it is unlikely that calcium channel blockers will emerge as important agents for post-MI prophylaxis.

— ASB

Published in Journal Watch General Medicine February 19, 1993

Citation(s):

Goldbourt U et al. Early administration of nifedipine in suspected acute myocardial infarction: the Secondary Prevention Reinfarction Israel Nifedipine Trial 2 Study. Arch Intern Med 1993 Feb 8 153 345-353.

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