A Cochrane review [Abstract] 1 on effect of early treatment with ACE inhibitors (12 studies), beta-blockers (20), calcium channel blockers (CCBs) (18 studies, n=2 141) and nitrates (18 studies) on short and long-term mortality in patients with an acute cardiovascular event included 65 studies with a total of 166 206 subjects. Of the 18 CCB studies, 12 included myocardial infarction (MI) patients and 6 included stroke patients. Immediate treatment (started within 24 hours of the onset and lasting for maximum 2 days) with CCBs was not associated with a statistically significant effect on all-cause mortality at 2 days (RR 2.33,95% CI 0.62 to 8.78; 3 studies, n=242). Only one trial (N=88) reported mortality at 10 days; there was one death in the CCB group and none in the control group. Only one trial (N=108) reported mortality at ≥ 30 days; there were 7/54 deaths in the CCB group and 5/54 in the control group (RR 1.40, 95% CI 0.47 to 4.14). Short-term treatment (started within 24 hours of the onset and lasting for a maximum of 10 days) was not associated with a statistically significant effect on all-cause mortality at 10 days (RR 1.01, 95% CI 0.73 to 1.38; 15 studies, n=1900). One study (N=90) reported mortality at ≥ 30 days; there were 3 deaths in the CCB group and 2 in the placebo group.
In sensitivity analyses, there was a trend towards a greater mortality among MI patients treated short-term with calcium channel blockers as compared to placebo (mortality at 10 days: RR 1.57 95% CI 0.87 to 2.83; 9 studies, n=847); particularly in those receiving dihydropyridine CCBs (RR 1.91, 95% CI 0.98 to 3.72; 4 studies, n=577). In acute stroke patients, CCBs were not associated with significant effect on mortality at 10 days (RR 0.81, 95% CI 0.54 to 1.21; 5 studies, n=1011).
Comment: The quality of ervidence is downgraded by study quality (unclear allocation concealment) and by inconsistency (variability in results across studies).
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