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Evidence summaries

Early Treatment with Calcium Channel Blockers in Acute Cardiovascular Event

Calcium channel blockers started within 24 hours of symptom onset in acute myocardial infarction may not decrease mortality and a non-significant trend towards increased mortality is seen after short-term use of these drugs at 10 days. Calcium channel blockers administered after acute stroke seem not to affect mortality, although the evidence is insufficient. Level of evidence: "C"

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).

    References

    • Perez MI, Musini VM, Wright JM. Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event. Cochrane Database Syst Rev 2009;(4):CD006743. [PubMed]

Primary/Secondary Keywords