Anti-ischaemic intervention with verapamil in patients recovering from acute myocardial infarction

The present review discusses the prognostic significance of post-infarction angina pectoris, and the significance of post-infarction intervention with verapamil on the prevalence of post-infarction ischaemia and prognosis. Angina pectoris during the first month after acute myocardial infarction (AMI) was found to be a significant predictor of subsequent major events (death and reinfarction) (P = 0·03). The prognosis in patients with post-infarction angina pectoris was as poor as that observed in patients with mild to moderate congestive heart failure. Intervention with verapamil significantly reduced the 1 month prevalence of angina pectoris (P = 0·02), and thereby also the number of patients at high risk. In patients with ST-segment depression provoked during a pre-discharge, post- infarction exercise test, intervention with verapamil reduced major events by 41 % compared with placebo. In patients with both heart failure and angina pectoris, anti-ischaemic intervention with verapamil reduced the 17 month event rate by 37%, whereas no effect was found in patients with heart failure, but no angina pectoris. We conclude that angina pectoris following AMI is a sign risk predictor in both patients with and without impaired cardiac function. Intervention with verapamil sign ficantly reduces post-infarction ischaemia, thereby reducing the risk of reinfarction and death.