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document
Prognostic significance and beneficial effect of diltiazem on the incidence of early recurrent ischemia after non-Q-wave myocardial infarction : results from the Multicenter Diltiazem Reinfarction Study . Of 576 patients with non-Q-wave acute myocardial infarction enrolled in the Diltiazem Reinfarction Study , 246 ( 43 % ) had 1 or more episodes of angina at rest or with minimal effort during 10.5 days of treatment with either diltiazem ( 90 mg every 6 hours ) or placebo . Reinfarction ( 12.2 % vs 3.6 % , p less than 0.0001 ) or death ( 6.1 % vs 1.5 % , p = 0.003 ) was more likely to occur within 2 weeks of randomization in patients with postinfarction angina than in those without angina . Based on serial electrocardiographic data , 115 of the 246 patients with angina had transient ST-T changes and 131 did not . Comparison of the 14-day event rates in these 2 groups showed that the 115 patients with electrocardiographic evidence of ischemia had a higher frequency of reinfarction ( 20 % vs 5.3 % , p less than 0.001 ) , more extensive damage as assessed by peak MB-creatine kinase levels ( 91 +/- 76 vs 37 +/- 19 IU/liter , p = 0.059 [ Wilcoxon rank sum ] ) and a higher mortality rate ( 11.3 % vs 1.5 % , p = 0.001 ) . Angina associated with transient ST-T changes occurred in 70 of the 289 patients in the placebo group but in only 45 of the 287 patients in the diltiazem group -- a 28 % reduction in cumulative life-table incidence ( p = 0.0103 [ 2-tail , log rank ] ; 95 % confidence interval , 9.3 to 53.8 % ) . It is concluded that patients with early postinfarction angina are at increased risk of reinfarction and death , and angina associated with transient electrocardiographic changes identified a very high risk subset . This subset appeared to have a larger area of viable but jeopardized myocardium and benefited from prophylactic therapy with diltiazem .
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Intervention_Pharmacological
diltiazem
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Intervention_Pharmacological
diltiazem
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Intervention_Control
placebo
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Intervention_Control
placebo
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Intervention_Pharmacological
diltiazem
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Outcome_Other
Prognostic significance
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Outcome_Other
beneficial effect
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Outcome_Physical
early recurrent ischemia
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Outcome_Physical
Reinfarction
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Outcome_Mortality
death
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Outcome_Physical
ST-T
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Outcome_Physical
reinfarction
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Outcome_Physical
extensive damage
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Outcome_Physical
peak MB-creatine kinase levels
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Outcome_Mortality
higher mortality rate
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Outcome_Physical
Angina
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Outcome_Physical
transient ST-T changes
75440
Outcome_Physical
cumulative life-table incidence
75441
Outcome_Mortality
risk of
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Outcome_Physical
reinfarction
75443
Outcome_Mortality
death
75444
Outcome_Physical
angina associated with transient electrocardiographic
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Outcome_Other
changes
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Outcome_Other
viable
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Outcome_Other
jeopardized myocardium
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Participant_Condition
early recurrent ischemia
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Participant_Sample-size
576
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Participant_Condition
non-Q-wave acute myocardial infarction
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Participant_Condition
early postinfarction angina