Efficacy of Nifedipine in Rest Angina Refractory to Propranolol and Nitrates in Patients with Obstructive Coronary Artery Disease

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Abstract
Patients [19] with recurrent rest angina were given oral nifedipine. All patients had chest discomfort refractory to propranolol and oral or topical nitrates given to tolerance. The addition of nifedipine, 30-120 mg daily, abolished rest angina in 14 patients, decreased its frequency in 2 and had no effect in 3 patients. Of 7 patients on long-term nifedipine (mean, 6.2 .+-. 3.4 mo.) 5 remained free of rest pain. Of 7 patients who had their nifedipine dose decreased or discontinued, 5 had recurrent rest angina. Of the 19 patients, 16 had coronary angiography. Five had 3 vessel obstructive disease (greater than 75% lesion), 6 had 2-vessel obstructive disease and 5 had 1-vessel obstructive disease. The remaining 3 unstudied patients had pathologic Q waves in the ECG. Nifedipine appears to be an efficacious agent in the treatment of refractory rest angina in patients with obstructive coronary artery disease.