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Ivabradine in patients with acute ST-elevation myocardial infarction: a meta-analysis of randomized controlled trials
Bryan Richard Sasmita1, Siyuan Xie1, Gang Liu1
1Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Insights
Ivabradine effectively reduces resting heart rate (HR) in patients with ST-elevation myocardial infarction (STEMI). While safe, it does not significantly impact mortality, suggesting elevated HR is a risk marker, not a modifiable outcome determinant in STEMI patients.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Elevated resting heart rate (HR) is linked to adverse outcomes in coronary artery disease.
- Ivabradine is a recommended second-line anti-anginal for chronic coronary syndrome.
- Clear indications for Ivabradine in acute ST-elevation myocardial infarction (STEMI) are lacking.
Purpose of the Study:
- To systematically evaluate the therapeutic and safety effects of Ivabradine in patients with acute myocardial infarction.
- To assess Ivabradine's impact on heart rate, mortality, heart failure, and left ventricular function.
- To determine Ivabradine's safety profile concerning troponin levels and ischemic events.
Main Methods:
- Systematic literature search of PubMed, Medline, EMBASE, Clinical Trials.gov, and Cochrane Central Register.
- Inclusion of 6 randomized controlled trials (RCTs) evaluating Ivabradine in acute myocardial infarction.
- Analysis of therapeutic outcomes (HR, mortality, heart failure, LV function/remodeling) and safety outcomes (troponin, ischemic events).
Main Results:
- Ivabradine significantly reduced resting heart rate (HR) [MD −5.40 bpm].
- Improvements observed in left ventricular ejection fraction [MD 2.98%] and end-systolic volume [MD −3.81 mL].
- No significant impact on all-cause mortality, heart failure incidence, or recurrent angina pectoris.
Conclusions:
- Ivabradine is safe and effective for reducing resting HR in STEMI patients.
- Ivabradine does not significantly influence mortality or recurrent ischemic events in this population.
- Elevated HR in STEMI may represent a risk marker rather than a modifiable factor for outcomes.
Background:
Elevated resting heart rate (HR) predicts poor outcomes in patients with coronary artery disease. Ivabradine has been recommended as a second-line anti-anginal agent in chronic coronary syndrome, while there are no clear indications for acute ST-elevation myocardial infarction (STEMI).
Results:
We systematically searched PubMed, Medline, EMBASE, Clinical Trials.gov, and the Cochrane Central Register of Controlled Trials with search terms Ivabradine and Acute myocardial infarction. There are two study outcomes from this study: therapeutic and safety effects. Therapeutic effects include the efficacy of Ivabradine on HR, all-cause mortality, heart failure incidence, left ventricular function and remodeling. Safety effects include troponin levels and ischemic events (recurrent angina pectoris). A total of 6 RCTs was included and showed that Ivabradine was associated with greater resting HR reduction [MD - 5.40; 95%CI - 8.60, - 2.20], improvement of left ventricular ejection fraction [MD 2.98; 95%CI 0.44, 5.51], and left ventricular end systolic volume [MD - 3.81; 95%CI - 6.88, - 0.75]. However, Ivabradine had no impact on all-cause mortality [OR 0.76; 95%CI 0.35, 1.67], heart failure incidence [OR 0.61; 95%CI 0.21, 1.80], and recurrent angina pectoris [OR 0.71; 95%CI 0.50, 1.00].
Conclusions:
Ivabradine is safe and effective for resting HR reduction in patients with STEMI; however, it has no significant influence on mortality. These results suggest that an elevated HR is only a marker of risk but not a modifiable determinant of outcomes in patients who have suffered an acute myocardial infarction.
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