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Secondary prevention after myocardial infarction: Effects of beta blocking agents and calcium antagonists

  • Part Four: Unstable Angina And Acute Myocardial Infarction
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Summary

Therapeutic interventions in patients with myocardial infarction, whether during the first hours after coronary occlusion or several days later, aim to reduce mortality and morbidity by several mechanisms: Prevention of fatal ventricular fibrillation, limitation of infarct size, and inhibition of platelet aggregation are some examples of such mechanisms. Results from early intervention trials with beta blocking agents, particularly from ISIS-I, suggest that 1-year mortality is significantly lower in selected patients randomized to active treatment. Late intervention studies also suggest a significant reduction in coronary mortality and morbidity with beta blockade, particularly when data are pooled.

Studies with the calcium channel blockers nifedipine and verapamil were unable to demonstrate any beneficial effects of these drugs on mortality or reinfarction.

In this review article, attention will be directed to the most recent information about the preventive value of beta adrenergic blocking drugs and slow calcium channel inhibitors.

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References

  1. Gordon T,, Kannel WB. Premature mortality from coronary heart disease; The Framingham study. JAMA 1971;215:1617.

    Google Scholar 

  2. Hunt D, Sloman G, Christie D et al. Changing patterns and mortality of acute myocardial infarction in a coronary care unit. Br Med J 1977;1:795.

    Google Scholar 

  3. Epstein S, Palmeri S, Patterson R. Evaluation of patients after myocardial infarction: Indication for cardiac catheterization and surgical intervention. N Engl J Med 1982;307:1487–1492.

    Google Scholar 

  4. De Feyter P, Van Eenige M, Dighton D et al. Prognosis value of exercice testing, coronary angiography and left ventriculography 6–8 weeks after myocardial infarction. Circulation 1982;66:527–535.

    Google Scholar 

  5. Weinblatt E, Shapiro S, Frank C et al. Prognosis of men after first myocardial infarction: Mortality and first reccurrence in relation to selected parameters. Am J Public Health 1968;58:1329.

    Google Scholar 

  6. Madsen E, Hougaard P, Gilpin E. Dynamic evaluation of prognosis from time-dependent variables in acute myocardial infarction. Am J Cardiol 1983;51:1579–1583.

    Google Scholar 

  7. Feinstein A. An additional basic science for clinical medicine II. The limitations of randomized trials. Ann Intern Med 1983;99:544.

    Google Scholar 

  8. Salonen J. Stopping smoking and the long-term mortality after acute myocardial infarction. Br Heart J 1980;43:463–469.

    Google Scholar 

  9. Snow P. The effect of propranolol on myocardial infarction. Lancet 1965;2:551–553.

    Google Scholar 

  10. Maseri A. Rationale for treatment in the first year after myocardial infarction. In: Maseri A, Goodwin F, eds. Hammermith Cardiology Workshop Series, Vol 1. New York: Raven Press, 1984:211–217.

    Google Scholar 

  11. Herlitz J, Hjalmarson A, Waldenstrom J. Relationship between enzymatically estimated infarct size and short and long term survival in acute myocardial infarction. Acta Med Scand 1984;216:261–267.

    Google Scholar 

  12. Braunwald E, Muller J, Kloner R et al. Role of beta-adrenergic blockade in the therapy of patients with myocardial infarction. Am J Med 1983;74:113–124.

    Google Scholar 

  13. Schaper W. Experimental infarcts and the microcirculation. In: Hearse DJ, Yellon DM, eds. Therapeutic Approaches to Myocardial Infarct Size Limitation. New York: Raven Press, 1984:79–80.

    Google Scholar 

  14. Gold H, Leinbach C, Maroko P. Propranolol-induced reduction of signs of ischemic injury during acute myocardial infarction. Am J Cardiol 1976;38:689–695.

    Google Scholar 

  15. Mueller H, Ayres S, Religa A et al. Propranolol in the treatment of acute myocardial infarction: Effect on myocardial oxygenation and hemodynamics. Circulation 1974;49:1078–1087.

    Google Scholar 

  16. Beta-blocker Heart Attack Trial Research Group. BHAT. A randomized trial of propranolol in patients with acute myocardial infarction. JAMA 1982;247:1707–1714.

    Google Scholar 

  17. Rossi P, Yusuf S, Ramsdale D et al. Reduction of ventricular arrhythmias by early intravenous atenolol in suspected acute myocardial infarction. Br Med J 1983;286:506–510.

    Google Scholar 

  18. The Norwegian Multicenter Study Group. NMCS-group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 1981;304:801–807.

    Google Scholar 

  19. Multicenter International Study group. Reduction in mortality after myocardial infarction with long-term beta-adrenoceptor blockade: Supplementary report. Br Med J 1977;2:419–421.

    Google Scholar 

  20. Lie K, Wellens H, Downar E et al. Observations on patients with primary ventricular fibrillation complicating acute myocardial infarction. Circulation 1975;52:755.

    Google Scholar 

  21. Josephson M. Treatment of ventricular arrhythmias after myocardial infarction. Circulation 1986;74:653–658.

    Google Scholar 

  22. Keefe D, Schwartz J, Somberg J. The substrate and the trigger: The role of myocardial vulnerability in sudden cardiac death. Am Heart J 1987;113:218–225.

    Google Scholar 

  23. Fitzgerald J. The action of beta antagonists in prolonging survival after myocardial infarction. In: Kulbertus HE, Wellens HJ, eds. The First Year After Myocardial Infarction.

  24. Hjalmarson A, Elmfeldt D, Herlitz J et al. Effect on mortality of metoprolol in acute myocardial infarction. A doubleblind randomized trial. Lancet 1981;2:823–827.

    Google Scholar 

  25. ISIS-1 collaborative group (First International Study of Infarct Survival). Randomised trial of intravenous atenolol 16, 027 cases of suspected acute myocardial infarction: ISIS-1 Lancet 1986;2:57–66.

    Google Scholar 

  26. Simoons M, Serruys P, Van Den Brand M, et al. Early thombolysis in acute myocardial infarction: Limitations of infarct size and improved survival. J Am Coll Cardiol 1986;7:717–728.

    Google Scholar 

  27. GISSI Gruppo Italiano per lo Stidio della Strptochinasi nell' Infarcto Miocardio. Effectiveness of intravenous thombolytic treatment in acute myocardial infarction. Lancet 1986;1:397–401.

    Google Scholar 

  28. de Bono D. Coronary thrombolysis. Br Heart J 1987;57:301–305.

    Google Scholar 

  29. Yusuf S, Peto R, Lewis J et al. Beta blockade during and after myocardial infarction: An overview of the randomized trials. Prog Cardiovasc Dis 1985;27:335–371.

    Google Scholar 

  30. Pratt G, Young J, Roberts R. The role of beta-blockers in the treatment of patients after infarction. Cardiology Clinics 1984;1:13–20.

    Google Scholar 

  31. Day J, Metcalfe J, Simpson C. Adrenergic mechanisms and control of plasma lipid concentrations. Br Med J 1982;284:1145–1148.

    Google Scholar 

  32. Lichstein E. Why do beta blockers decrease mortality after myocardial infarction? JACC 1986;6:973–975.

    Google Scholar 

  33. Julian D, Jackson F, Prescott R et al. Controlled trial of sotalol for one year after myocardial infarction. Lancet 1982;1:1142–1147.

    Google Scholar 

  34. Holbrook J, Grundy S, Hennekens C et al. Cigarette smoking and cardiovascular disease. A statement for health professionals by a task force appointed by the steering committee of the American Heart Association. Circulation 1984; 70:1114A.

    Google Scholar 

  35. Nayler W., Sturrock W. Calcium antagonists and the ischaemic myocardium. Eur Heart J 1987;7(B):27–34.

    Google Scholar 

  36. Yoshida S, Downey J, Friedman F et al. Nifedipine limits infarct size for 24 hours in closed chest coronary embolized dogs. Basic Res Cardiol 1985;80:76–87.

    Google Scholar 

  37. Wilcox R, Hampton J, Banks D, Birkhead J, Brooksby I, Burns-Cox C., Hayes M, Joy M, Malcom A, Mather H, Rowley J. Trial of early nifedipine in acute myocardial infarction: The Trent study. Br Med J 1986;293:1204–1209.

    Google Scholar 

  38. Muller J, Morrison J, Storne P et al. Nifedipine therapy for patients with threatened and acute myocardial infarction: A randomised, double-blind, placebo controlled comparison. Circulation 1984;69:740–747.

    Google Scholar 

  39. Sirnes P, Overskeid K, Pedersen T et al. Evolution of infarct size during the early use of nifedipine in patients with acute myocardial infarction: The Norwegian nifedipine multicenter trial. Circulation 1984;70:638–644.

    Google Scholar 

  40. Danish Study Group on Verapamil in Myocardial Infarction. Verapamil in acute myocardial infarction. Eur Heart J 1984;5:516–529.

    Google Scholar 

  41. Yusuf S, Furberg C et al. Effect of acute or chronic administration of calcium antagonists on mortality following myocardial infarction. JACC 1987;2(Suppl A):24.

    Google Scholar 

  42. Hugenholtz P, Serruys P, Fleckenstein A et al. Why Ca2+ antagonists will be most useful before or during early myocardial ischaemia and not after infarction has been established. Eur Heart J 1986;7:270–278.

    Google Scholar 

  43. European Infarction Study Group. A secondary prevention study with slow release oxprenolol after myocardial infarction: Morbidity and mortality. Eur Heart J 1984;5:189–202.

    Google Scholar 

  44. Taylor S, Silke B, Ebbut A et al. A long-term prevention study with oxprenolol in coronary heart disease. N Engl J Med1982;307:1293–1301.

    Google Scholar 

  45. Taylor S, Silke B, Ebbut A et al. Prevention of heart disease with oxprenolol. N Engl J Med 1983;308:1162–1163.

    Google Scholar 

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Authors and Affiliations

  1. Medical Cardiology Services Hôpital Académique Erasme, Université Libre de Bruxelles, Belgium

    P. Depelchin, J. Sobolski, M. Jottrand & C. Flament

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  1. P. Depelchin
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  2. J. Sobolski
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  3. M. Jottrand
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  4. C. Flament
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Depelchin, P., Sobolski, J., Jottrand, M. et al. Secondary prevention after myocardial infarction: Effects of beta blocking agents and calcium antagonists. Cardiovasc Drug Ther 2, 139–147 (1988). https://doi.org/10.1007/BF00054265

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