Effectiveness and safety of ivabradine in the treatment of acute myocardial infarction: a systematic review and meta-analysis

Abstract

Background: Cardiovascular diseases have become a prominent threat to public health and quality of life.In recent years, some studies have reported that ivabradine can improve the cardiac function and prognosis of patients with acute myocardial infarction (AMI). Methods: We searched China National Knowledge Infrastructure (CNKI), Wanfang database, Chinese Biomedical Literature (CBM), Chongqing Weipu Chinese Sci-tech Journal Database (VIP), PubMed, Cochrane Library, and EMBASE for randomized controlled trials (RCTs) of ivabradine in the treatment of AMI from January 1980 until December 2020. Each RCT was systematically reviewed. Results: A total of 7 RCTs with 658 patients were included. Compared with the control group, the heart rate [mean deviation (MD) =−9.20, 95% confidence interval (CI): −13.03 to −5.38, P<0.00001] and brain natriuretic peptide (BNP) (MD =−112.73, 95% CI: −186.12 to −39.35, P=0.003) of patients who received ivabradine combined with conventional standard treatment were significantly lower and left ventricular ejection fraction (LVEF) (MD =3.17, 95% CI: 2.12 to 4.23, P<0.00001) was significantly better. The difference in adverse events was not statistically significant [odds ratio (OR) =2.45, 95% CI: 0.92 to 6.55, P=0.07].Discussion: Ivabradine combined with β-blockers can reduce the resting heart rate and improve heart function in patients with AMI while not increasing adverse events. However, due to limitations in the number and quality of studies included, our conclusions need to be further confirmed by analyzing more studies.

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

“…However, after comparing the two groups' absolute differences in LVEF, we found that Ivabradine led to the preservation of LV function compared to the non-Ivabradine group. In fact, there is another meta-analysis conducted by Wang et al [28], who found that Ivabradine had higher LVEF improvement [MD 3.17; 95%CI 2.12, 4.23] compared to our study [MD 2.98; 95%CI 0.44, 5.51]. The possible explanation was mainly due to the differences in the search strategy and inclusion criteria, as our study did not include studies published in Chinese.…”

Long-Term Pharmacological Management of Reduced Ejection Fraction Following Acute Myocardial Infarction: Current Status and Future Prospects

“…None has more than 85 patients. Although a meta-analysis of the available trials 22 found that ivabradine does reduce heart rate and is associated with better left ventricular systolic function and a lower NT-proBNP, only 658 patients were included in total, and it is not possible to draw any firm conclusions. Ivabradine should not be used in preference to up-titration of beta-blockade to target dose.…”