Calcium antagonists are frequently prescribed for patients with hypertension and coronary artery disease (CAD). Because recent studies have raised concern about the safety of these drugs, a large trial of verapamil in patients with CAD may have public health relevance. This study was conducted to assess whether verapamil, when compared to placebo, decreases total mortality, cardiac mortality, reinfarction, and angina after an acute myocardial infarction (AMI). The study was a double-blind, randomized, placebo-controlled trial. Patients ranged between the ages of 30 to 75 years, without contraindications to verapamil or a history of severe heart failure were enrolled 7 to 21 days after AMI. 531 patients were randomized to receive verapamil retard 360 mg/day, and 542 patients to placebo. The baseline characteristics of both groups were similar. Treatment was discontinued in 36.9% of the placebo group and 35.6% of the verapamil group. Reinfarction and severe angina were more common reasons for stopping treatment in the placebo group than in the verapamil group. No differences between verapamil and placebo were observed in total mortality (n = 30 and 29, respectively) and cardiac death (n = 21 and 22, respectively). The verapamil group had nonsignificant lower reinfarction rates (n = 39 vs. 49). The number of patients developing angina was significantly less in the verapamil group (n = 100 vs. 132, RR = 0.8, 95% confidence interval 0.5 to 0.9). There were no differences in discontinuation of therapy due to adverse reactions. This trial provides evidence that verapamil can be useful to decrease ischemic symptoms after AMI. The issue of mortality reduction after AMI with the use of verapamil needs further evaluation. According to available knowledge, agents with proven efficacy on survival including aspirin, β-blockers, and angiotensin-converting enzyme inhibitors should be used as first-line drugs in the secondary prevention of myocardial infarction.