Ivabradine vs metoprolol in patients with acute inferior wall myocardial infarction—“Expanding arena for ivabradine”

Abstract

Ivabradine is well tolerated and equally effective as metoprolol in acute inferior wall ST elevation myocardial infarction patients for lowering the heart rate with lesser risk of AV blocks.

A Prospective Considerations and Comparative Efficacy Between Ivabradine vs Beta Blockers in South Indian Acute Coronary Syndrome Patients

“…Therefore, existing guidelines for STEMI have given Class-I recommendation to oral beta-blockers therapy administration promptly to patients without contraindications. Betablockers have the propensity to cause AV block and there is a 19% incidence of high degree heart block complicating acute inferior infarction [16]. However, the use of beta-blockers is restricted in some patient's subgroups with severe LV dysfunction and acute bronchospasm or having cardiac conduction abnormalities.…”

“…Betablockers are the most regularly used first-line therapy. The use of β-blockers is complex and controversial in patients with conduction abnormalities, severe LV dysfunction and active bronchospasm, severe airway obstruction, chronic fatigue, cardiogenic shock, hypersensitive to β-blockers, severe hypertension, peripheral vascular disease, patient on ventilator, persistent tachycardia, and post-operative persistent tachycardia [16]. Ivabradine quite the reverse to beta-blockers has been shown better myocardial perfusion.…”

“…Ivabradine is a selective inhibitor of the funny current (I f ). Inhibition of I f are associated with reduction in sinus rate and a prolong sinus recovery time and reduced infarct size [9][10][11][12][13][14][15][16][17]. Ivabradine should be administered in symptomatic patients (New York Heart Association [NYHA] II-IV) with left ventricular (LV) EF ≤35% [18].…”

Effect of ivabradine on major adverse cardiovascular events and mortality in critically ill patients: a systematic review and meta-analyses of randomised controlled trials with trial sequential analyses

“…Two trials reported the incidence of MACE, 31,40 and an additional trial reported the incidence of a composite outcome 37 of death and cardiovascular endpoints (for details regarding the definitions of MACE in each trial, please refer to the online Supplementary material) in ivabradine and control groups. One trial reported the incidence of MACE in the whole cohort only, and data could not be analysed 35 (the authors were contacted, but no answer was obtained).…”

“…Six trials reported data on the incidence of new or worsening heart failure. 32,34,36,37,40,41 There were 23 (3.8%) events in the ivabradine group and 35 (6.1%) in the control group with no evidence of a difference between groups (six RCTs, n¼1177; OR¼0.59; 95% CI, 0.23e1.50; P¼0.27) ( Supplementary Fig. S3a).…”