The efficacy of Ivabradine in post-acute myocardial infarction: a meta-analysis

Background: In the normal, non-diseased state, the heart rate is controlled by the sinoatrial node, which is the origin of cardiac pacemaker activity. Pacemaker activity involves interplay between several ionic currents that influence spontaneous diastolic depolarisation of the sinoatrial node, which is the primary site of the effect of Ivabradine. This meta-analysis aims to determine whether Ivabradine has a significant effect on the reduction of heart rate and improvement in left ventricular ejection fraction among acute myocardial infarction patients.

Methods: Relevant trials were retrieved from Pubmed and Cochrane database. All prospective, randomized and placebo-controlled clinical trials and relevant prospective cohort studies were considered and carefully reviewed. The authors independently evaluated the studies to determine whether they met the inclusion and exclusion criteria. The information extracted included patient characteristics, age, documented myocardial infarction (whether via ECG, 2D echocardiography or cardiac biomarkers) and percutaneous coronary intervention. Review Manager software version 5.3 was used in the analysis of the outcomes.

Results: Two studies were included for analysis; one randomized controlled trial and one prospective cohort which compared Ivabradine to a control group. The outcome was determined by comparing the heart rate and left ventricular ejection fraction of patients from both treatment arms. The results indicated that the use of IV Ivabradine after PCI for STEMI produced a rapid and sustained reduction in heart rate, which was safe and well tolerated. Furthermore, both studies revealed a reduction in both LV systolic and diastolic end volumes. Results however were heterogenous.

Conclusion: The authors conclude that Ivabradine has no significant effect in the reduction of heart rate and LV ejection.