Efficacy of nifedipine in rest angina refractory to propranolol and nitrates in patients with obstructive coronary artery disease.

Nineteen patients 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 to 120 mg daily, abolished rest angina in 14 patients, decreased its frequency in two, and had no effect in three patients. Five of seven patients on long-term nifedipine (mean, 6.2 +/- 3.4 months) remained free of rest pain. Of seven patients who had their nifedipine dose decreased or discontinued, five had recurrent rest angina. Of the 19 patients, 16 had coronary angiography. Five had three- vessel obstructive disease (greater than 75% lesion), six had two-vessel obstructive disease, and five had one-vessel obstructive disease. The remaining three unstudied patients had pathologic Q waves in the ECG. Thus nifedipine appears to be an efficacious agent in the treatment of refractory rest angina in patients with obstructive coronary artery disease.