Nifedipine, 12 RCTs with 9,464 patients; diltiazem, 5 RCTs with 3,151 patients; verapamil, 4 RCTs with 5,293 patients; and lidoflazine, 1 RCT with 1,792 patients.
None of the effects were found to be statistically significant. Nifedipine increased the odds of mortality by 13% (95% confidence interval, CI: -3, 32), and increased the odds of reinfarction by 14% (95% CI: -12, 49). Verapamil reduced the odds of mortality by 9% (95% CI: -18, 8), and reduced the odds of reinfarction by 18% (95% CI: -35, 2). Diltiazem showed no change in the odds of mortality (95% CI: -20, 23), and reduced the odds of reinfarction by 21% (95% CI: -39, 2). Lidoflazine showed no effect on mortality.
There is a trend in those with non-Q-wave MI to show a greater benefit, which is marginally statistically significant, when treated with diltiazem. There is a trend for those with clinical heart failure, left ventricular dysfunction or pulmonary congestion to show a reduced benefit, or even harm, when treated with diltiazem or verapamil.