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Diltiazem Prevents Death and Myocardial Infarction during Non-cardiac Surgery: Presented at AHA

By Jill Stein

CHICAGO, IL -- November 26, 2002 -- The calcium channel blocker diltiazem significantly reduces the frequency of cardiac complications during non-cardiac surgery, suggest new data reported here November 20 at the 2002 Scientific Sessions of the American Heart Association (AHA).

Dr. Duminda N. Wijeysundera, with the University of Toronto, in Toronto, Ontario, Canada, presented the results of a meta-analysis of all randomized controlled trials evaluating calcium channel blockers in non-cardiac surgery available on MEDLINE (1966 through December 2001) and EMBASE (1980 through December 2001).

"Cardiac complications following non-cardiac surgery increase mortality, morbidity, and healthcare costs," Dr. Wijeysundera pointed out. "Calcium channel blockers may improve the balance between myocardial oxygen demand and supply. Their role in preventing perioperative complications, however, remains unclear."

The 15 trials included in the meta-analysis (with a total of 992 patients) compared calcium channel blockers to non-calcium channel blockers during non-cardiac surgery and reported any of the following outcomes: death, myocardial infarction (MI), ischemia, and supraventricular tachyarrhythmias (SVT). The analysis excluded studies with patients who were organ transplant recipients, who had undergone cerebral aneurysm repair, and who had been treated for SVT.

Calcium channel blockers significantly reduced ischemia (risk ratio [RR] 0.48, p=0.004) and SVT (RR= 0.51, p=0.00007), and were associated with trends towards decreased death (RR 0.25, p=0.07) and MI (RR 0.25, p=0.08).

Given the small number of outcomes, the researchers performed post hoc analyses using combined end points. Calcium channel blockers reduced major morbid events, which included death, myocardial infarction, congestive heart failure (RR 0.2, p=0.04) and death/MI (RR 0.24, p=0.02).

Diltiazem reduced ischemia (RR 0.34, p=0.00005), SVT (RR 0.54, p=0.00009), major morbid events (RR0.27, p=0.02), and death/MI (RR0.26, p=0.02).

Dr. Wijeysundera said results of this meta-analysis justify further study of perioperative calcium channel blockers, especially diltiazem, in a large, high-quality, double-blinded, randomized, controlled trial.

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