SECONDARY PREVENTION OF DEATH AND REINFARCTION WITH VERAPAMIL AFTER AN ACUTE MYOCARDIAL-INFARCTION

The effect of verapamil on death, reinfarctions, and major events i.e. reinfarction or death, has been investigated in two Danish double-blind, placebo-controlled verapamil infarction trials DAVIT I and II. DAVIT I, which was an early intervention trial, demonstrated that after six months there was a statistically non-significant reduction of mortality and reinfarction. DAVIT II demonstrated a non-significant reduction of mortality rate (P = 0.11, hazard ratio 0.80, 95% confidence limits 0.61-1.05), a significant reduction of reinfarction rate (P = 0.04, 0.77, 0.58-1.03), and major event rate (P = 0.03, 0.80, 0.64-0.99) in the verapamil group compared with the placebo group. Meta-analyses of DAVIT I (including only patients alive on day eight) and of DAVIT II showed a statistically significant reduction of odds ratio of mortality of 22% (P = 0.04), of reinfarctions of 27% (P = 0.02), and of major events of 21% (P = 0.02). It is concluded that long-term treatment with verapamil after an acute myocardial infarction is associated with a significant reduction in overall mortality, major events, and reinfarction rates.