Ivabradine in patients with acute ST-elevation myocardial infarction: a meta-analysis of randomized controlled trials

• Published in: The Egyptian heart journal 2023-04, Vol.75 (1), p.25-9, Article 25
• Main Authors: Sasmita, Bryan Richard, Xie, Siyuan, Liu, Gang, Zhu, Yuansong, Luo, Suxin, Huang, Bi
• Format: Article
• Language: English
• Subjects: Acute ST-elevation myocardial infarction; Analysis; Angina pectoris; Beta blockers; Bias; Cardiac patients; Cardiology; Care and treatment; Clinical trials; Data analysis; Ejection fraction; Health aspects; Heart; Heart attack; Heart attacks; Heart beat; Heart failure; Heart rate; Ivabradine; LV function; LV remodeling; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Meta-analysis; Mortality; Prognosis; Review; Sensitivity analysis
• ISSN: 2090-911X; 1110-2608; 2090-911X
• DOI: 10.1186/s43044-023-00351-8

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.