Efficacy and safety of Ivabradine in management of ACS-STEMI: A systematic review and meta-analysis

Tóm tắt

Background: Acute coronary syndrome remains one of the most important causes of morbidity and mortality worldwide. Modern therapies have been extensively studied to address this condition including ivabradine. Ivabradine is a drug that effectively lowers heart rate through selective and specific inhibition of If (funny) current resulting in decreased myocardial oxygen demand. The pharmacodynamic properties of ivabradine does not seem to affect the conduction pathways and no effect on ventricular contractility. However, the potential of ivabradine in treating acute ischemic events has yet to be fully understood and its pleiotropic and anti-ischemic effects might acutely limit the extent of myocardial injury.

Methods: A systematic review and meta-analysis were conducted to evaluate ivabradine's efficacy. The controlled group are those who received ivabradine therapy. The included randomized clinical trials were divided into two subgroups based on whether patients underwent percutaneous coronary intervention. Clinical endpoints were assessed, including all-cause mortality, major adverse cardiac events, heart rate control, and left ventricular function.

Results: There was no significant association between the studies regarding all-cause mortality (p-value 0.96). The controlled group showed a significant reduction in arrhythmia events in both subgroups, either with or without PCI (Chi-squared = 1.14, df = 1, P = 0.29). There was no significant difference between the two subgroups regarding heart failure (Chi-squared = 1.87, df = 1, P = 0.17). There was a significant difference between the two subgroups regarding ischemic events (Chi-squared = 8.05, df = 1, P <0.01). Both subgroups showed a significant reduction in heart rate when ivabradine was added (Chi-squared = 0.15, df = 1, P = 0.70). Lastly, neither group had any difference in left ventricular function regardless of whether PCI was done (Chi-squared = 0.03, df = 1, P = 0.8).

Conclusion: The use of ivabradine effectively controlled heart rate and reduced the incidence of ischemic events. There was no significant association between ivabradine use and all-cause mortality, but there was an increased incidence of atrial fibrillation. There are potential safety concerns with ivabradine, including the risk of bradycardia, AV blocks, and rhythm instability. More research is needed to determine the safety of ivabradine in ACS. The conclusions of this analysis may be limited by the relatively short follow-up periods, and further research with more extended follow-up periods may be necessary.