Egyptian Journal of Critical Care Medicine (Aug 2015)

The effect of ivabradine on long term prevention of major adverse cardiac events in acute coronary syndrome using high-sensitivity C-reactive protein level

  • Ahmed Fouad AbdEl Latif,
  • Wael Samy,
  • Mohamed Y. Khaled,
  • Alia Abd El Fattah

DOI
https://doi.org/10.1016/j.ejccm.2015.12.003
Journal volume & issue
Vol. 3, no. 2
pp. 77 – 81

Abstract

Read online

Introduction: C-reactive protein (CRP) value can identify the risk level for acute coronary syndrome (ACS). Ivabradine, a selective inhibitor of the funny current channel, reduces resting and exercise HR without affecting cardiac contractility or blood pressure. Aim of work: Evaluate the influence of Ivabradine on long term prevention of major adverse cardiac events (MACE) using high sensitivity crp (hs CRP). Methodology: 60 pts were admitted with ACS over the period of 6 months. Cardiac enzymes were withdrawn on admission and every 6 h thereafter for 24 h then followed up daily for five days and when indicated. High sensitivity C-reactive protein (hs-CRP) (quantitative value) which was done on day of admission and repeated for follow up at day 4 and at day 30 patients divided into two groups each 30 pts: group (A) who received conventional therapy & ivabradine, group (B) who received conventional therapy only. Ivabradine given within 48 h of admission 5 mg twice daily upgraded to 7.5 mg twice daily after one week if tolerable Myocardial perfusion imaging (MPI): Patients were subjected to Technetium99 sesta MIBI Myocardial perfusion imaging (MPI) within 6–8 h after admission and were followed up on day 30 with the same dose of injection using multi-spect Siemens dual head gamma Camera. Results: There were significant variances in Hs-CRP value at day 30 in both groups (P value < 0.001). Patients of group A showed statistically significant lower level of hs-CRP at day 30 compared to group B (0.7 ± 0.3 mg/dl versus 1.66 ± 0.9 mg/dl; P value < 0.001) but there was no statistically significant difference between both groups regarding 30 days follow up MACE (P value 0.552). Conclusion: Administration of ivabradine within 48 h of CCU admission decreased hs-CRP level in patients with acute coronary syndrome (unstable angina) but did not decrease the occurrence of major cardiac events in ACS patients.

Keywords