Electrocardiographic subset analysis of diltiazem administration on long-term outcome after acute myocardial infarction

William E. Boden, Ronald J. Krone, Robert E. Kleiger, David Oakes, Henry Greenberg, Edward J. Dwyer, J. Philip Miller, Jonathan Abrams, James Coromilas, Robert Goldstein, Arthur J. Moss

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

The effect of diltiazem on long-term outcome after acute myocardial infarction (AMI) was assessed in 2,377 patients enrolled in the Multicenter Diltiazem Post-Infarction Trial and subsequently followed for 25 ± 8 months. The study population included 855 patients (36%) with at least 1 prior AMI before the index infarction and 1,522 patients (64%) with a first AMI, of whom 409 (27%) had a first non-Q-wave AMI, 664 (44%) a first inferior Q-wave AMI, and 449 (30%) a first anterior Q-wave AMI. This post hoc analysis revealed that, among patients with first non-Q-wave and first inferior Q-wave AMI, there were fewer cardiac events during follow-up in the diltiazem than in the placebo group, and that the reverse was true for patients with first anterior Q-wave AMI or prior infarction. The diltiazem:placebo Cox hazard ratio (95% confidence limits) for the trial primary end point (cardiac death or nonfatal reinfarction, whichever occurred first) was: first non-Q-wave AMI-0.48 (0.26, 0.89); first inferior Q-wave AMI-0.66 (0.40, 1.09); first anterior Q-wave AMI-0.82 (0.51, 1.31); and prior AMI-1.11 (0.85, 1.44). Use of cardiac death alone as an end point gave an even more sharply focused treatment difference: first non-Q-wave AMI-0.46 (0.18, 1.21); first inferior Q-wave AMI-0.53 (0.27, 1.06); first anterior Q-wave AMI-1.28 (0.68, 2.40); prior infarction-1.26 (0.90, 1.77). Further analysis revealed that these differences in the effect of diltiazem in large part reflected the different status of the 4 electrocardiographically defined subsets in terms of left ventricular function. Mean (± standard deviation) ejection fraction for patients with first non-Q-wave AMI (placebo, 0.53 ± 0.13; diltiazem, 0.54 ± 0.12) was comparable to that of patients with a first inferior Q-wave AMI (placebo, 0.52 ± 0.10; diltiazem, 0.52 ± 0.11), and both these first AMI subsets had a lower frequency of radiographic pulmonary congestion range (10 to 16%) during the acute infarction than did patients with first anterior Q-wave or prior AMI. Mean ejection fraction for the subset of patients with first anterior Q-wave AMI (placebo, 0.38 ± 0.13; diltiazem, 0.40 ± 0.12) was comparable to that of patients with at least 1 prior AMI (placebo, 0.44 ± 0.15; diltiazem, 0.43 ± 0.14) and the frequency of pulmonary congestion in these 2 infarct subsets ranged from 24 to 26%. The differential effect of diltiazem on postinfarction outcome in these electrocardiographically categorized AMI subsets appears closely linked to the bidirectional effect of diltiazem (beneficial in the majority of patients with well-preserved left ventricular function, harmful in the minority with impaired left ventricular function) that was elucidated in the primary Multicenter diltiazem Post-Infarction Trial analysis. In patients with multiple infarctions complicated by left ventricular dysfunction, diltiazem appears to be detrimental. Patients with first non-Q-wave or first inferior Q-wave infarction generally have well-preserved left ventricular function and appear to benefit from diltiazem.

Original languageEnglish (US)
Pages (from-to)335-342
Number of pages8
JournalThe American Journal of Cardiology
Volume67
Issue number5
DOIs
StatePublished - Feb 15 1991
Externally publishedYes

Fingerprint

Diltiazem
Myocardial Infarction
Infarction
Placebos
Left Ventricular Function

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Boden, William E. ; Krone, Ronald J. ; Kleiger, Robert E. ; Oakes, David ; Greenberg, Henry ; Dwyer, Edward J. ; Miller, J. Philip ; Abrams, Jonathan ; Coromilas, James ; Goldstein, Robert ; Moss, Arthur J. / Electrocardiographic subset analysis of diltiazem administration on long-term outcome after acute myocardial infarction. In: The American Journal of Cardiology. 1991 ; Vol. 67, No. 5. pp. 335-342.
@article{58ba1c70650b499d82766df52e46c98a,
title = "Electrocardiographic subset analysis of diltiazem administration on long-term outcome after acute myocardial infarction",
abstract = "The effect of diltiazem on long-term outcome after acute myocardial infarction (AMI) was assessed in 2,377 patients enrolled in the Multicenter Diltiazem Post-Infarction Trial and subsequently followed for 25 ± 8 months. The study population included 855 patients (36{\%}) with at least 1 prior AMI before the index infarction and 1,522 patients (64{\%}) with a first AMI, of whom 409 (27{\%}) had a first non-Q-wave AMI, 664 (44{\%}) a first inferior Q-wave AMI, and 449 (30{\%}) a first anterior Q-wave AMI. This post hoc analysis revealed that, among patients with first non-Q-wave and first inferior Q-wave AMI, there were fewer cardiac events during follow-up in the diltiazem than in the placebo group, and that the reverse was true for patients with first anterior Q-wave AMI or prior infarction. The diltiazem:placebo Cox hazard ratio (95{\%} confidence limits) for the trial primary end point (cardiac death or nonfatal reinfarction, whichever occurred first) was: first non-Q-wave AMI-0.48 (0.26, 0.89); first inferior Q-wave AMI-0.66 (0.40, 1.09); first anterior Q-wave AMI-0.82 (0.51, 1.31); and prior AMI-1.11 (0.85, 1.44). Use of cardiac death alone as an end point gave an even more sharply focused treatment difference: first non-Q-wave AMI-0.46 (0.18, 1.21); first inferior Q-wave AMI-0.53 (0.27, 1.06); first anterior Q-wave AMI-1.28 (0.68, 2.40); prior infarction-1.26 (0.90, 1.77). Further analysis revealed that these differences in the effect of diltiazem in large part reflected the different status of the 4 electrocardiographically defined subsets in terms of left ventricular function. Mean (± standard deviation) ejection fraction for patients with first non-Q-wave AMI (placebo, 0.53 ± 0.13; diltiazem, 0.54 ± 0.12) was comparable to that of patients with a first inferior Q-wave AMI (placebo, 0.52 ± 0.10; diltiazem, 0.52 ± 0.11), and both these first AMI subsets had a lower frequency of radiographic pulmonary congestion range (10 to 16{\%}) during the acute infarction than did patients with first anterior Q-wave or prior AMI. Mean ejection fraction for the subset of patients with first anterior Q-wave AMI (placebo, 0.38 ± 0.13; diltiazem, 0.40 ± 0.12) was comparable to that of patients with at least 1 prior AMI (placebo, 0.44 ± 0.15; diltiazem, 0.43 ± 0.14) and the frequency of pulmonary congestion in these 2 infarct subsets ranged from 24 to 26{\%}. The differential effect of diltiazem on postinfarction outcome in these electrocardiographically categorized AMI subsets appears closely linked to the bidirectional effect of diltiazem (beneficial in the majority of patients with well-preserved left ventricular function, harmful in the minority with impaired left ventricular function) that was elucidated in the primary Multicenter diltiazem Post-Infarction Trial analysis. In patients with multiple infarctions complicated by left ventricular dysfunction, diltiazem appears to be detrimental. Patients with first non-Q-wave or first inferior Q-wave infarction generally have well-preserved left ventricular function and appear to benefit from diltiazem.",
author = "Boden, {William E.} and Krone, {Ronald J.} and Kleiger, {Robert E.} and David Oakes and Henry Greenberg and Dwyer, {Edward J.} and Miller, {J. Philip} and Jonathan Abrams and James Coromilas and Robert Goldstein and Moss, {Arthur J.}",
year = "1991",
month = "2",
day = "15",
doi = "10.1016/0002-9149(91)90038-M",
language = "English (US)",
volume = "67",
pages = "335--342",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "5",

}

Boden, WE, Krone, RJ, Kleiger, RE, Oakes, D, Greenberg, H, Dwyer, EJ, Miller, JP, Abrams, J, Coromilas, J, Goldstein, R & Moss, AJ 1991, 'Electrocardiographic subset analysis of diltiazem administration on long-term outcome after acute myocardial infarction', The American Journal of Cardiology, vol. 67, no. 5, pp. 335-342. https://doi.org/10.1016/0002-9149(91)90038-M

Electrocardiographic subset analysis of diltiazem administration on long-term outcome after acute myocardial infarction. / Boden, William E.; Krone, Ronald J.; Kleiger, Robert E.; Oakes, David; Greenberg, Henry; Dwyer, Edward J.; Miller, J. Philip; Abrams, Jonathan; Coromilas, James; Goldstein, Robert; Moss, Arthur J.

In: The American Journal of Cardiology, Vol. 67, No. 5, 15.02.1991, p. 335-342.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Electrocardiographic subset analysis of diltiazem administration on long-term outcome after acute myocardial infarction

AU - Boden, William E.

AU - Krone, Ronald J.

AU - Kleiger, Robert E.

AU - Oakes, David

AU - Greenberg, Henry

AU - Dwyer, Edward J.

AU - Miller, J. Philip

AU - Abrams, Jonathan

AU - Coromilas, James

AU - Goldstein, Robert

AU - Moss, Arthur J.

PY - 1991/2/15

Y1 - 1991/2/15

N2 - The effect of diltiazem on long-term outcome after acute myocardial infarction (AMI) was assessed in 2,377 patients enrolled in the Multicenter Diltiazem Post-Infarction Trial and subsequently followed for 25 ± 8 months. The study population included 855 patients (36%) with at least 1 prior AMI before the index infarction and 1,522 patients (64%) with a first AMI, of whom 409 (27%) had a first non-Q-wave AMI, 664 (44%) a first inferior Q-wave AMI, and 449 (30%) a first anterior Q-wave AMI. This post hoc analysis revealed that, among patients with first non-Q-wave and first inferior Q-wave AMI, there were fewer cardiac events during follow-up in the diltiazem than in the placebo group, and that the reverse was true for patients with first anterior Q-wave AMI or prior infarction. The diltiazem:placebo Cox hazard ratio (95% confidence limits) for the trial primary end point (cardiac death or nonfatal reinfarction, whichever occurred first) was: first non-Q-wave AMI-0.48 (0.26, 0.89); first inferior Q-wave AMI-0.66 (0.40, 1.09); first anterior Q-wave AMI-0.82 (0.51, 1.31); and prior AMI-1.11 (0.85, 1.44). Use of cardiac death alone as an end point gave an even more sharply focused treatment difference: first non-Q-wave AMI-0.46 (0.18, 1.21); first inferior Q-wave AMI-0.53 (0.27, 1.06); first anterior Q-wave AMI-1.28 (0.68, 2.40); prior infarction-1.26 (0.90, 1.77). Further analysis revealed that these differences in the effect of diltiazem in large part reflected the different status of the 4 electrocardiographically defined subsets in terms of left ventricular function. Mean (± standard deviation) ejection fraction for patients with first non-Q-wave AMI (placebo, 0.53 ± 0.13; diltiazem, 0.54 ± 0.12) was comparable to that of patients with a first inferior Q-wave AMI (placebo, 0.52 ± 0.10; diltiazem, 0.52 ± 0.11), and both these first AMI subsets had a lower frequency of radiographic pulmonary congestion range (10 to 16%) during the acute infarction than did patients with first anterior Q-wave or prior AMI. Mean ejection fraction for the subset of patients with first anterior Q-wave AMI (placebo, 0.38 ± 0.13; diltiazem, 0.40 ± 0.12) was comparable to that of patients with at least 1 prior AMI (placebo, 0.44 ± 0.15; diltiazem, 0.43 ± 0.14) and the frequency of pulmonary congestion in these 2 infarct subsets ranged from 24 to 26%. The differential effect of diltiazem on postinfarction outcome in these electrocardiographically categorized AMI subsets appears closely linked to the bidirectional effect of diltiazem (beneficial in the majority of patients with well-preserved left ventricular function, harmful in the minority with impaired left ventricular function) that was elucidated in the primary Multicenter diltiazem Post-Infarction Trial analysis. In patients with multiple infarctions complicated by left ventricular dysfunction, diltiazem appears to be detrimental. Patients with first non-Q-wave or first inferior Q-wave infarction generally have well-preserved left ventricular function and appear to benefit from diltiazem.

AB - The effect of diltiazem on long-term outcome after acute myocardial infarction (AMI) was assessed in 2,377 patients enrolled in the Multicenter Diltiazem Post-Infarction Trial and subsequently followed for 25 ± 8 months. The study population included 855 patients (36%) with at least 1 prior AMI before the index infarction and 1,522 patients (64%) with a first AMI, of whom 409 (27%) had a first non-Q-wave AMI, 664 (44%) a first inferior Q-wave AMI, and 449 (30%) a first anterior Q-wave AMI. This post hoc analysis revealed that, among patients with first non-Q-wave and first inferior Q-wave AMI, there were fewer cardiac events during follow-up in the diltiazem than in the placebo group, and that the reverse was true for patients with first anterior Q-wave AMI or prior infarction. The diltiazem:placebo Cox hazard ratio (95% confidence limits) for the trial primary end point (cardiac death or nonfatal reinfarction, whichever occurred first) was: first non-Q-wave AMI-0.48 (0.26, 0.89); first inferior Q-wave AMI-0.66 (0.40, 1.09); first anterior Q-wave AMI-0.82 (0.51, 1.31); and prior AMI-1.11 (0.85, 1.44). Use of cardiac death alone as an end point gave an even more sharply focused treatment difference: first non-Q-wave AMI-0.46 (0.18, 1.21); first inferior Q-wave AMI-0.53 (0.27, 1.06); first anterior Q-wave AMI-1.28 (0.68, 2.40); prior infarction-1.26 (0.90, 1.77). Further analysis revealed that these differences in the effect of diltiazem in large part reflected the different status of the 4 electrocardiographically defined subsets in terms of left ventricular function. Mean (± standard deviation) ejection fraction for patients with first non-Q-wave AMI (placebo, 0.53 ± 0.13; diltiazem, 0.54 ± 0.12) was comparable to that of patients with a first inferior Q-wave AMI (placebo, 0.52 ± 0.10; diltiazem, 0.52 ± 0.11), and both these first AMI subsets had a lower frequency of radiographic pulmonary congestion range (10 to 16%) during the acute infarction than did patients with first anterior Q-wave or prior AMI. Mean ejection fraction for the subset of patients with first anterior Q-wave AMI (placebo, 0.38 ± 0.13; diltiazem, 0.40 ± 0.12) was comparable to that of patients with at least 1 prior AMI (placebo, 0.44 ± 0.15; diltiazem, 0.43 ± 0.14) and the frequency of pulmonary congestion in these 2 infarct subsets ranged from 24 to 26%. The differential effect of diltiazem on postinfarction outcome in these electrocardiographically categorized AMI subsets appears closely linked to the bidirectional effect of diltiazem (beneficial in the majority of patients with well-preserved left ventricular function, harmful in the minority with impaired left ventricular function) that was elucidated in the primary Multicenter diltiazem Post-Infarction Trial analysis. In patients with multiple infarctions complicated by left ventricular dysfunction, diltiazem appears to be detrimental. Patients with first non-Q-wave or first inferior Q-wave infarction generally have well-preserved left ventricular function and appear to benefit from diltiazem.

UR - http://www.scopus.com/inward/record.url?scp=0025978502&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025978502&partnerID=8YFLogxK

U2 - 10.1016/0002-9149(91)90038-M

DO - 10.1016/0002-9149(91)90038-M

M3 - Article

C2 - 1994656

AN - SCOPUS:0025978502

VL - 67

SP - 335

EP - 342

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 5

ER -