Calcium antagonists have proved effective in stable angina, unstable angina and vasospastic angina. However, despite a strong theoretical rationale for their use and promising experimental data, these agents have not reduced infarct size in acute myocardial infarction (AMI) in the large clinical trials performed to date. Their role as adjunctive therapy in combination with reperfusion needs to be examined. Diltiazem has been demonstrated to reduce angina and reinfarction in the 2-week period after AMI in patients receiving multidrug therapy. Results of the single large trial of a calcium antagonist (verapamil) for secondary prevention after AMI were negative; however, several well-designed studies are currently ongoing.