Efficacy of Ivabradine versus β-Blockers for Heart Rate Reduction during Computed Tomography Coronary Angiography: A Meta-Analysis of Randomized Controlled Trials

Abstract

Objective: To quantify the efficacy of pretreatment with ivabradine compared to β-blockers before computed tomography coronary angiography (CTCA) via a meta-analysis of clinical randomized controlled trial data. Methods: We conducted a search for randomized controlled trials of pretreatment with ivabradine compared to β-blockers before CTCA in Medline, PubMed, Embase, SCI/SSCI/A&HCI, SAS Publishers, Web of Science, and the Cochrane Central Register. The Jadad quality score of the included studies, and the mean difference (MD) in heart rate reduction, were indicators of efficacy. RevMan 5.2 and Stata 12.0 software were used for the meta-analysis. Results: Eight studies involving a total of 1,324 patients were included in the final analysis. The results showed that ivabradine was significantly more effective at improving the heart rate of patients achieving the target heart rate (<65 bpm) during CTCA (OR 5.02; 95% CI 3.16-7.98, p < 0.00001, I² = 20%). A comparison of efficacy between ivabradine and β-blockers showed a statistically significant effect of ivabradine on heart rate reduction during CTCA (MD -4.39; 95% CI −4.80 to −3.99, p < 0.00001, I² = 0%). Ivabradine also led to a significant reduction in heart rate prior to CTCA (MD −5.33; 95% CI −10.26 to −0.39, p = 0.03, I² = 92%). In terms of the total reduction in heart rate during CTCA, significant differences were noted between the ivabradine group and the β-blocker group (MD 2.64; 95% CI 1.25-4.02, p = 0.0002, I² = 0%). The mean percentage reduction in heart rate in the ivabradine group was significantly higher than that in the β-blocker group (MD 7.18; 95% CI 5.64-8.72, p < 0.00001, I² = 43%). Ivabradine had no significant effect on either systolic blood pressure (BP) (MD 11.41; 95% CI 6.43-16.40, p < 0.00001, I² = 85%) or diastolic BP (MD 1.79; 95% CI -0.00 to 3.58, p = 0.05, I² = 56%). Conclusion: Compared to β-blockers for heart rate reduction, ivabradine is a potentially attractive alternative for patients undergoing CTCA.

Ivabradine: Evidence and current role in cardiovascular diseases and other emerging indications

“…Compared with beta-blockers, ivabradine showed significant effect on HR reduction during CTCA. Ivabradine also showed significant reduction in HR before CTCA without significant effect on BP 46 . Overall, these studies suggest that ivabradine is an attractive option for reducing HR in patients undergoing CTCA.…”

Beyond Heart Failure and Ischemic Heart Disease: A Scoping Review of Novel Uses of Ivabradine in Adults

“…The remaining studies showed a benefit in HR reduction and/or image quality with ivabradine including patients treated with and without concomitant β‐blockers 68,69,71–73,75,76,78,80,83 . A meta‐analysis of eight studies demonstrated ivabradine was superior to β‐blockers in lowering HR during the scan 84 …”

Low-dose ultra-high-pitch computed tomography coronary angiography: identifying the optimum combination of iteration strength and radiation dose reduction strategies to achieve true submillisievert scans

“…HR control medication, such as beta-blockers have long attempted to achieve this objective, but have numerous drawbacks and contraindications. However, newer drugs such as ivabradine, a funny channel blocker, have recently been successfully used and in studies proved more efficacious in lowering and stabilizing the HR (13)(14)(15). We, therefore, incorporated this into the protocol to establish the utility of a single dose of ivabradine in lowering the HR.…”