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Calcium channel blockers in myocardial infarction: Authors' reply

care units do not have an acute myocardial infarction; but to be sure that all patients with an infarct were treated, treatment should start immediately in all patients-without exclusion criteriaadmitted with a suspicion of acute myocardial infarction. Treatment should then stop if a diagnosis of acute myocardial infarction was ruled out. This means that we did not intend to treat the 3447 patients in coronary care units but only the 1436 with acute myocardial infarction. Naturally the effect of verapamil in patients who were treated but did not fulfil the inclusion criteria should be reported from a trial with such a design. We find it impossible, however, to evaluate the effect of verapamil on death and reinfarction after an infarct in the 2011 patients without acute myocardial infarction, most ofwhom were treated for only two or three days and none for more than a week. Based on the intention to treat principle and including all available trials with verapamil, which are all early intervention trials, an analysis shows a reduction in pooled odds ratio of 0 11 of mortality (table) and not an increased pooled odds ratio. The number of patients in verapamil trials (n= 1568) is still small compared with the numbers included in nifedipine (n=9464) and diltiazem (n=3151) trials, and a beneficial effect of verapamil on mortality and reinfarction cannot be excluded. A report ofthe results ofa further multicentre Danish verapamil infarction trial (DAVIT II) with late intervention is in preparation.