RT Journal
A1 Jollis JG, Simpson RJ, Jr, Chowdhury MK, et al
T1 CAlcium channel blockers and mortality in elderly patients with myocardial infarction
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1999
FD October 1
VO 159
IS 19
SP 2341
OP 2348
DO 10.1001/archinte.159.19.2341
UL http://dx.doi.org/10.1001/archinte.159.19.2341
AB Background 
    Although calcium channel blockers are a useful therapy in relieving angina, lowering blood pressure, and slowing conduction of atrial fibrillation, growing evidence has cast doubt on their safety in patients with coronary disease.Objective 
    To examine the association between calcium channel blocker therapy at hospital discharge and mortality in a population-based sample of elderly patients hospitalized with acute myocardial infarction.Design 
    Retrospective cohort study using data from medical charts and administrative files.Setting 
    All acute care hospitals in 46 states.Patients 
    All Medicare patients with a principal diagnosis of acute myocardial infarction consecutively discharged from the hospital alive during 8-month periods between 1994 and 1995 (N = 141,041).Main Outcome Measure 
    Mortality at 30 days and 1 year.Results 
    Calcium channel blockers were widely prescribed at hospital discharge to elderly patients with myocardial infarction between 1994 and 1995 (n = 51,921), the most commonly prescribed being diltiazem (n = 21,175), nifedipine (n = 12,670), amlodipine (n = 11,683), and verapamil (n = 3639). After adjusting for illness severity and concomitant medication use, patients who were prescribed calcium channel blockers at hospital discharge did not have increased risk for 30-day or 1-year mortality, with the exception of the few (n = 116) treated with bepridil. Bepridil differs from other calcium channel blockers because of its tendency to prolong repolarization, and its association with proarrhythmic effects in elderly patients.Conclusion 
    We did not identify a mortality risk in a large consecutive sample of elderly patients with myocardial infarction, which supports the need for additional prospective trials examining calcium channel blocker therapy for ischemic heart disease.