THE EFFECTS OF NISOLDIPINE ON THE TOTAL ISCHEMIC BURDEN - THE RESULTS OF THE ROCKET STUDY

This study was designed to examine the effects of nisoldipine (relative to placebo), a new dihydropyridine calcium entry blocking agent, in the treatment of silent ischaemia in conventional doses.A total of 409 patients with proven coronary artery disease were screened and of this 64 had at least six episodes or a total duration of 30 mm of ST segment depression (1 mm lasting at least 1 min) over 48 h. Fifty-two patients ultimately completed a randomized double-blind cross-over study comparing nisoldipine 5 mg twice a day, nisoldipine 10 mg daily and placebo.There was a reduction in the ST segment integral and number of episodes of ST segment depression when compared to placebo on treatment with nisoldipine 5 mg twice a day and nisoldipine 10 mg daily. However, the confidence limits were wide and crossed the no-treatment effect line. In addition, the nisoldipine doses neither affected the circadian distribution of ischaemic episodes nor caused an alteration of the workload achieved either at peak exercise or at 1 mm ST segment depression measured 24 h after nidoldipine 10 mg or 12 h after nisoldipine 5 mg.We conclude that frequent silent ischaemia in patients with proven coronary artery disease is relatively uncommon, it accounts for approximately 16% of patients with positive exercise. In these patients nisoldipine, given as 5mg twice a day and 10 mg daily, showed no significant therapeutic effects, either on the frequency or severity of silent ischaemia. New formulations of slow release nisoldipine are consequently being developed so that a fuller 24 h therapeutic profile may be obtained. © 1991 The European Society of Cardiology.