Ivabradin treatment in patients with acute coronary syndrome

Abstract

Purpose: To assess the efficacy and safety of early administration of ivabradin in addition to metoprolol in patients (pts) with acute coronary syndrome (ACS) Methods: The study included 98 ACS pts (64% men), mean age 72 (60; 76) years, with sinus rhythm and heart failure Killip class I. Pts were randomly assigned to metoprolol+ivabradin (M+Iv) group (n=50) and metoprolol (M) group (n=48) dose up‐titration for 14 days. Mean doses were 100 (75; 125) mg for M and 10 (10; 10) mg for Iv in M+Iv group pts and 100 (100; 150) mg in M group pts We evaluated heart rate (HR) at rest, systolic and diastolic blood pressure (BP), ECG parameters, incidence and duration of myocardial ischemia during 24 hour ECG monitoring and treadmill test, 6‐minute walk test (6‐MWT). The primary end point of efficacy was achievement of target HR less 60 bpm at the 14th day of treatment. The primary combined end point of safety included incidence of arterial hypotension, sinoatrial and atrioventricular conduction disturbance, bronchial obstruction and visual disturbance. Results: At the 14th day target HR by ECG measuring was achieved in 45 (90%) pts of M+Iv group and 40 (83%) pts of M group (p=0.33). Mean HR less 60 bpm measured by 24 hour ECG monitoring was observed in 38 (76%) and 30 (63%) respectively (p=0.14). There were no significant differences in BP level, incidence and duration ischemic episodes and result of 6‐MWT. The primary combined end point of safety was documented in 9 (18%) pts of M+Iv group and 18 (38%) pts of M group (p=0.03). Conclusion: Combined treatment with metoprolol and ivabradine showed a favorable safety profile and same antiischemic activity compared with metoprolol up‐titration regimen in ACS pts.