Efficacy of ivabradin in combined treatment of patients with postinfarction systolic chronic cardiac failure

Abstract

Aim. To study effects of ivabradin on clinicohemodynamic and prognostic parameters in patients after myocardial infarction (MI) with systolic chronic cardiac failure (SCCF). Material and methods. A population-based randomized prospective trial enrolled 49 patients (40 males - 81,6%, mean age 63,1 ± 8,1 years) with sinus rhythm and a longer than 3 month history of MI. The patients were randomized into 2 groups: 23 patients of group 1 received standard treatment plus ivabradin, 26 patients of group 2 received standard treatment alone. Follow-up was 36,1 ± 6,2 months. We analysed the trend in heart rate (HR), blood pressure (BP), parameters of echocardiography, ECG, levels of electrolytes, creatinin in blood plasma, frequency of hospitalizations, recurrent non-fatal MI and lethality (combined end point). Results. In the end of the trial ivabradin significantly decreased HR from 71 to 64 b/m. Frequency of combined end point of efficacy was 30,4 and 50% in group 1 and 2, respectively. In group 1 primary end point in high baseline HR occurred more frequently than in HR < 70 b/m in 6 (50%) and 1 (9,1%) cases, respectively, but these differences were not significant (p = 0,068). In group 2 the differences were significant - 9 (90%) and 4 (25%) cases, respectively (p = 0,004). By none of the parameters of ECG, plasma electrolytes, creatinine level significant intergroup differences were found. Conclusion. In the same trend in BP and ECG, group 1 patients showed significant and more pronounced HR lowering than group 2 patients. Addition of ivabradin to standard treatment of SCCF after MI promoted less frequency of hospitalizations, recurrent non-fatal MI, fatal cardiovascular events. This effect was especially strong in high baseline HR.

Keywords

• ivabradin
• myocardial infarction
• chronic cardiac failure
• electrocardiogram
• echocardiogram