Efficacy of ivabradin in combined treatment of patients with postinfarction systolic chronic cardiac failure
Aim: To study effects ofivabradin 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 HRfrom 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.