Related Experiment Video
Updated: Mar 19, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Ivabradine in Patients with ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: A Preliminary
Francesco Barillà1,2, Giuseppe Pannarale3, Concetta Torromeo3
1Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy. francesco.barilla@uniroma1.it.
Insights
Ivabradine is safe and effective for treating cardiogenic shock complicating myocardial infarction, improving heart function and potentially reducing mortality. This heart rate-lowering agent can be administered via nasogastric tube.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Elevated heart rate (HR) is a significant risk factor for mortality and morbidity in acute heart failure (HF).
- Cardiogenic shock (CS) complicating ST-elevation acute myocardial infarction (AMI) presents a critical clinical challenge.
Purpose of the Study:
- To evaluate the impact of ivabradine, a selective HR-lowering agent, on patients experiencing CS post-AMI.
- To assess the safety and efficacy of ivabradine in this high-risk patient population.
Main Methods:
- Randomized controlled trial comparing standard treatment (SDT) with SDT plus ivabradine (I+SDT) in post-AMI CS patients.
- Ivabradine administered via nasogastric intubation if orotracheal intubation was present.
- Monitoring of HR, BP, NYHA class, NT-proBNP, LVEF, and LVDF; primary endpoint was in-hospital halving of NT-proBNP.
Main Results:
- In-hospital mortality was lower in the I+SDT group (6.7%) compared to the SDT group (14.3%), though not statistically significant.
- Both groups showed favorable changes in HR, BP, NT-proBNP, and LVEF, with more significant improvements in the I+SDT group.
- Left ventricular diastolic function (LVDF) significantly improved only in the I+SDT group (p < 0.01).
- No adverse effects were reported in patients receiving ivabradine.
Conclusions:
- Ivabradine is safe for use in CS complicating AMI.
- The drug is associated with short-term favorable outcomes, including improved hemodynamic and functional parameters.
- Effective administration via nasogastric intubation is feasible.
Background And Objective:
An elevated heart rate (HR) is an independent risk factor for mortality and morbidity in patients with acute heart failure (HF). The purpose of this study was to evaluate the impact of ivabradine, a selective HR-lowering agent, in patients with cardiogenic shock (CS) complicating ST-elevation acute myocardial infarction (AMI).
Methods:
Patients with post-AMI CS were randomized to standard treatment (SDT, 28 patients) or to standard treatment plus ivabradine (I + SDT, 30 patients). In the presence of orotracheal intubation (OTI), ivabradine was administered by nasogastric intubation. HR, BP, New York Heart Association (NYHA) class, NT-proBNP, left ventricular ejection fraction (LVEF) and diastolic function (LVDF) were monitored at specific times after the onset of AMI. The primary (surrogate) end-point was the in-hospital halving of plasma NT-proBNP levels. The secondary end-points were cardiovascular death, hospital re-admission for worsening HF, and clinical and haemodynamic improvement.
Results:
Treatment groups were statistically similar with regard to age, gender distribution, cardiovascular risk factors, number of diseased vessels and overall treated lesions, AMI site and occurrence of OTI. In-hospital mortality was double in the SDT group in comparison with the I + SDT group (14.3 vs. 6.7 %), but the difference was not statistically significant. HR, BP, NT-proBNP and LVEF favorably changed in both groups, but the change was more relevant in the I + SDT group. LVDF significantly changed only in the I + SDT group (p < 0.01). Patients in the I + SDT group did not experience adverse effects.
Conclusion:
Ivabradine in CS complicating AMI is safe, is associated with a short-term favourable outcome and can be effectively administered by nasogastric intubation.
Related Concept Videos
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:26Heart Failure Drugs: Inotropic Agents
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
01:22Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
01:22Heart Failure Drugs: β-Blockers