Comparison of diltiazem and nifedipine alone and in combination in patients with coronary artery spasm

Abstract

Fifteen patients with coronary artery spasm completed a double-blind placebo-controlled trial comparing diltiazem and nifedipine. Increasingly, higher daily doses (diltiazem, 90 to 360 mg; nifedipine, 30 to 120 mg) were administered to achieve optimal clinical effects. Daily diaries and ambulatory electrocardiographic recordings were used to assess efficacy and side effects. Both drugs significantly decreased angina frequency compared with that in the preceding placebo period (diltiazem 1.4 +/- 0.4 [mean +/- SEM] to 0.4 +/- 0.2 episodes per day; nifedipine 1.4 +/- 0.3 to 0.4 +/- 0.1 episodes per day; both p less than 0.05). Ambulatory electrocardiographic recordings showed fewer ST shifts than were expected during all treatment periods (0.02/h recorded during placebo, none during diltiazem and 0.02/h during nifedipine therapy). Although some patients responded better to one drug than the other, neither drug resulted in a clearly superior clinical response. Diltiazem was discontinued in one patient because of urticaria, but the total number of side effects was higher with nifedipine (12 of 15 patients) than with diltiazem (5 of 15, p less than 0.01). Nine patients remained symptomatic on single drug treatment and entered open label treatment with the combination of diltiazem and nifedipine. Three patients did not tolerate the combination because of important side effects; the other six also had side effects, but these were relatively minor. Four patients received no more benefit from the combination than from a single agent; the condition of two patients improved. Both diltiazem and nifedipine provide effective antianginal therapy for coronary spasm, but diltiazem has fewer side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

High incidence of provoked coronary spasm in the presence of a stent after myocardial infarction

“…They further showed that provoked coronary spasm was the strongest predictor of MACE during the follow-up [16]. CCBs have been shown to be highly effective in suppressing coronary spasms and improve the prognosis of patients with coronary spasms [1,2,10,11,17,18]. CCBs, however, had not been given to the majority of the patients with provoked spasms in the study of Wakabayashi et al [16].…”

Successful Management of Refractory Lethal Coronary Spasm after Off-Pump Coronary Bypass Grafting

“…7) In some settings, coronary spasm is refractory to vasodilating agents and induces malignant arrhythmia and circulatory collapse. To treat this condition, many medications such as magnesium Rho-kinase inhibitors 8) or nifedipine 9) have been proposed. Stent implantation is also considered being an option.…”

Coronary Artery Multistenting in the Treatment of Life-Threatening Refractory Coronary Spasm After Coronary Artery Bypass Grafting

“…Zaiac, et al 6) reported the usefulness of intravenous nifedipine for the refractory coronary spasm after CABG. Prida, et al 7) also reported the combination of nifedipine and diltiazem for patients with coronary spasm which was resistant to single drug treatment. Thus, the additional use of nifedipine for resolving the spasm should be attempted.…”