Several calcium antagonists are useful in the treatment of ischemic heart disease. This open randomized study was designed to determine the effects ofbepridfl, a new long-acting calcium antagonist with antiarrhythmic properties, on the course of acute myocardial infarction (AMI), Two hundred patients with AMI of less than 48 hours duration (average 10.9 hours) were randomly assigned to two treatment groups: The first one was treated with bepridil (BEP, n = 100), and the second one was considered as a control group, using isosorbide dinitrate at a low dosage (ISDN, n = 100). BEP was administered intravenously for 48 hours at a dosage of 4 mg/kg/day; at the same time, an oral dose of 200 mg t.i.d. was started and continued for 21 days. In the control group, ISDN was given orally at the low dosage of 5 mg every 4 hours for 21 days. An unevent£ul course was seen in 28 BEP patients versus 15 in the control group (p < 0.05). Mortality and recurrence of angina were lower in the BEP group than in the control group, but the difference is not significant. On the other hand, moderate and severe hemodynamic complications did not occur in 80 BEP patients versus 65 in the control group (p < 0.05). Ventricular arrhythmias occurred in 36 BEP patients versus 50 in the control group (p < 0.05). Antiarrhythmic therapy was required in 14 BEP patients versus 61 in the control group (p < 0.001). These results show that bepridil seems capable of improving the hemodynamics and arrhythmologic course of AMI. KEY WORDS. myocardial infarction, calcium antagonists, bepridil.
The prognosis of myocardial infarction (MI) has been shown to be unfavorable during the first month in 36% to 50% of cases [1,2]. Half the deaths occur within the first hour due to ventricular fibrillation [3][4][5][6].
Several recent multicenter studies [7-13] indicate that there is great interest in beta-adrenergic blockade, initiated some weeks after myocardial infarction, to reduce long-term mortality, although the interest does not yet seem to be shared with caLcium-channel antagonists [14][15][16].
However, the value of early intervention in the acute phase of an evolving MI with either of these drugs is uncertain, especially with regard to the reduction of infarct size and short-term mortality [17][18][19][20]. Nevertheless, the clinical course of such patients, mainly if they are treated with beta blockers, seems more favorable than that of control groups in terms of the occurrence of acute complications. This could be explained by either