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著者: Philip A Poole-Wilson, Jacobus Lubsen, Bridget-Anne Kirwan, Fred J van Dalen, Gilbert Wagener, Nicolas Danchin, Hanjörg Just, Keith A A Fox, Stuart J Pocock, Tim C Clayton, Michael Motro, John D Parker, Martial G Bourassa, Anthony M Dart, Per Hildebrandt, Ake Hjalmarson, Johannes A Kragten, G Peter Molhoek, Jan-Erik Otterstad, Ricardo Seabra-Gomes, Jordi Soler-Soler, Simon Weber, Coronary disease Trial Investigating Outcome with Nifedipine gastrointestinal therapeutic system investigators
雑誌名: Lancet. 2004 Sep 4-10;364(9437):849-57. doi: 10.1016/S0140-6736(04)16980-8.
Abstract/Text
BACKGROUND: Calcium antagonists are widely prescribed for angina pectoris but their effect on clinical outcome is controversial. We aimed to investigate the effect of the calcium antagonist nifedipine on long-term outcome in patients with stable angina pectoris.
METHODS: We randomly assigned 3825 patients with treated stable symptomatic coronary disease to double-blind addition of nifedipine GITS (gastrointestinal therapeutic system) 60 mg once daily and 3840 to placebo. The primary endpoint was the combination of death, acute myocardial infarction, refractory angina, new overt heart failure, debilitating stroke, and peripheral revascularisation. Mean follow-up was 4.9 years (SD 1.1). Analysis was by intention to treat.
FINDINGS: 310 patients allocated nifedipine died (1.64 per 100 patient-years) compared with 291 people allocated placebo (1.53 per 100 patient-years; hazard ratio 1.07 [95% CI 0.91-1.25], p=0.41). Primary endpoint rates were 4.60 per 100 patient-years for nifedipine and 4.75 per 100 patient-years for placebo (0.97 [0.88-1.07], p=0.54). With nifedipine, rate of death and any cardiovascular event or procedure was 9.32 per 100 patient-years versus 10.50 per 100 patient-years for placebo (0.89 [0.83-0.95], p=0.0012). The difference was mainly attributable to a reduction in the need for coronary angiography and interventions in patients assigned nifedipine, despite an increase in peripheral revascularisation. Nifedipine had no effect on the rate of myocardial infarction.
INTERPRETATION: Addition of nifedipine GITS to conventional treatment of angina pectoris has no effect on major cardiovascular event-free survival. Nifedipine GITS is safe and reduces the need for coronary angiography and interventions.
PMID 15351192 Lancet. 2004 Sep 4-10;364(9437):849-57. doi: 10.1016/S0140-6736(04)16980-8.
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