Clinical InvestigationComparison of Ivabradine Versus Metoprolol in Early Phases of Reperfused Anterior Myocardial Infarction With Impaired Left Ventricular Function: Preliminary Findings
Section snippets
Population
Between December 2007 and January 2009, 567 consecutive patients were admitted with STEMI.
Eligibility Criteria
Patients had to have a first anterior episode of STEMI, Killip class I–II, an acceptable echocardiographic window, and had to be admitted within 4 hours of the onset of symptoms (pain). On electrocardiogram (ECG), there had to be an ST elevation of 0.1 mm in the peripheral leads or 2 mm in precordial leads, involving more than 1 lead, with concomitant alterations of the segmentary kinetics in the
Results
Of the 567 consecutive patients admitted with acute myocardial infarction, only 155 patients (50 female, 105 males) with anterior STEMI met the entry criteria and were included into the study. These patients were randomized (double blind) in 2 groups: a group received β-blockers (76 patients) 12 hours after successful PCI and the other group received ivabradine (79 patients) 12 hours after successful PCI.
The 2 groups were similar for clinical characteristics. Table 1 shows the baseline clinical
Discussion
The most interesting results of this study were the feasibility, tolerability, and safety in patients with anterior STEMI with impaired LV function receiving interventional reperfusion. The ivabradine group showed a significant reduction in ESV and EDV compared with the metoprolol group after 2 months (P < .0001). The EF showed a significant improvement after 30 and 60 days (P < .0001) and a significant increase in comparison with the metoprolol group (P < .017 and .01). In addition, both
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2022, American Heart Journal Plus: Cardiology Research and PracticeEffect of ivabradine on cardiac arrhythmias: Antiarrhythmic or proarrhythmic?
2021, Heart RhythmCitation Excerpt :However, ivabradine reduced AF incidence in combination with bisoprolol42 or metoprolol43 in patients undergoing cardiac surgery (Table 2). Three smaller RCT were conducted with ivabradine in acute ST-elevation myocardial infarction, enrolling in total over 400 patients (Table 2).44–46 No differences were found between ivabradine and the comparator (placebo, metoprolol.
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
2020, British Journal of AnaesthesiaCitation Excerpt :Five trials reported data on incidence of bradycardia,34,36,38,39,41 with only one trial comparing ivabradine with beta-blockers.34 Bradycardia was defined as an HR of <60 beats min−1 34 36 or <75 beats min−1,38 whereas two studies did not report details of the definition.39 41 There were 25 (10.3%) episodes in the ivabradine and 17 (8.8%) in the control group with no evidence of a difference between groups (five RCTs, n=434; OR=1.2; 95% CI, 0.60–2.38; P=0.61) (Supplementary Fig. S7a).
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2017, Cardiac Electrophysiology ClinicsIvabradine in acute coronary syndromes: Protection beyond heart rate lowering
2017, International Journal of CardiologyCitation Excerpt :Both drugs significantly reduced HR, while BP reduction was greater with metoprolol. Notably, Ivabradine was associated with a significantly greater increase in EF and reduction of end-systolic (ESV) and end-diastolic (EDV) volumes when compared to metoprolol [50]. Similarly, a randomized, double-blind pilot study examined the safety of intravenous Ivabradine vs. placebo after successful percutaneous coronary intervention (PCI) performed within 6 h of STEMI symptom onset [51].
Ivabradine prolongs phase 3 of cardiac repolarization and blocks the hERG1 (KCNH2) current over a concentration-range overlapping with that required to block HCN4
2015, Journal of Molecular and Cellular Cardiology