Presentatie - vzw farmaka asbl

Calcium-antagonisten
Gami P. Secondary prevention of ischaemic cardiac events. Clinical Evidence 2007.
Design N/n Population Sd Interventions Outcomes Results
MA
(search
date
1993)
N=24 Early or late
in the
course of
acute MI or
unstable
angina
pectoris
-Any calcium channel
blocker (dihydropyridines,
diltiazem, verapamil)
-Placebo
N=3 -Verapamil or diltiazem
-Placebo
Mortality
Mortality
ARD= +0.4% (95% CI –0.4% to +1.2%) in
favour of CCB
OR= 0.95 (95%CI 0.82 to 1.09) in favour
of CCB
Decreased rates of recurrent infarction and refractory angina with active treatment with
diltiazem or verapamil but only for those people without signs or symptoms of heart
failure.
-Dihydropyridines
-Placebo
Mortality
OR= 1.16 (95% CI 0.99 to 1.35) in favour
of placebo
Several individual RCTs of dihydropyridines found increased mortality, particularly
when these agents were started early in the course of acute MI and in the absence of
β-blockers.
Nissen. CAMELOT study. JAMA 2004;292:2217-25 + Minerva 2006; 5(5): 79-82 + Consensusvergadering angor november
2006
Design n Population Sd Interventions Outcomes Results
RCT 1991 - 30 to 79 y,
requiring coronary
angiography for
evaluation
for chest pain or
PCI
- +/- 40% history of
MI
24
m
-Amlodipine
10 mg
-Enalapril 20
mg
-Placebo
Primary endpoint: cardiovascular
events (cv death, nonfatal MI,
resuscitated cardiac arrest,
coronary revascularization,
hospitalization for angina,
hospitalization for heart failure,
stroke, new diagnosis of peripheral
vascular disease)
Secondary endpoint: all cause
mortality
16.6% (amlodipine) vs
23.1%
HR= 0.69 (95%CI 0.54
to 0.88)
(only SS difference for
revascularisation and
hospitalisation for
angina)
1.1% vs 0.9%
HR= 1.14 (95%CI 0.38
to 3.40)