Ivabradine vs metoprolol in patients with acute inferior wall myocardial infarction-"Expanding arena for ivabradine"

• Published in: Cardiovascular therapeutics Vol. 35; no. 4
• Main Authors: Priti, Kumari, Ranwa, Bhanwar L, Gokhroo, Rajendra K, Kishore, Kamal, Bisht, Devendra Singh, Gupta, Sajal
• Format: Journal Article
• Language: English
• Published: England 01-08-2017
• Subjects: Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; Arrhythmias, Cardiac - prevention & control; Atrioventricular Block - chemically induced; Benzazepines - adverse effects; Benzazepines - therapeutic use; Cardiotonic Agents - adverse effects; Cardiotonic Agents - therapeutic use; Double-Blind Method; Electrocardiography; Endpoint Determination; Female; Heart Block - prevention & control; Heart Failure - prevention & control; Humans; Inferior Wall Myocardial Infarction - complications; Inferior Wall Myocardial Infarction - drug therapy; Inferior Wall Myocardial Infarction - mortality; Male; Metoprolol - adverse effects; Metoprolol - therapeutic use; Middle Aged; Prospective Studies; Recurrence; Survival Analysis; Metoprolol; Atrioventicular blocks; Inferior wall myocardial infarction; Ivabradine
• ISSN: 1755-5922
• DOI: 10.1111/1755-5922.12266

Atrioventricular (AV) blocks are of concern with the use of beta blockers in inferior wall myocardial infarction (MI). Ivabradine lowers heart rate with a lesser risk of AV blocks.
To compare ivabradine with metoprolol in acute inferior wall MI in terms of feasibility, tolerability, and efficacy.
It was a prospective double-blind single-center randomized controlled study. Of 1032 patients with acute inferior wall MI, 468 eligible patients were randomized in 1:1 manner to ivabradine (group A) and metoprolol (group B). Intention to treat analysis of 426 patients (group A-232 and group B-232) was performed. The primary endpoint was 30-day incidence of major adverse cardiovascular events including death, reinfarction, complete heart block (CHB), and heart failure. Secondary endpoints included 30 days incidence of recurrent angina, readmission, first- or second-degree AV block, and tachyarrhythmias.
Both the drugs decreased the mean heart rate to 62.22±2.95 (group A) vs 62.53±3.59 (group B) beats per minute (P=0.33). Ejection fraction improved in both the groups (5.15±1.93% in group A vs 5.52±2.18% in group B, P=0.065). The two groups did not differ significantly in their primary endpoints in terms of death (group A=1.72% vs group B=1.72%, OR=1.00, 95% CI=0.25-4.05, P=1.00), reinfarction (group A=0.86% vs group B=0.86%, OR=1.00, 95% CI=0.14-7.16, P=1.00), heart failure (group A=4.31% vs group B=2.59%, OR=1.70, 95% CI=0.61-4.75, P=0.31), or CHB (0% vs 2.59%, OR=0.07, 95% CI=0.00-1.34, P=0.08). There were no significant differences in the secondary endpoints of recurrent angina, readmission, and tachyarrhythmias except for more first- and second-degree AV blocks with metoprolol (12.93% vs 2.59%, OR=5.59, 95% CI=2.28-13.72, P=0.0002).
Ivabradine is well tolerated and equally effective as metoprolol in acute inferior wall ST elevation myocardial infarction patients for lowering the heart rate with lesser risk of AV blocks.