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Efficacy of Ivabradine versus beta-blockers for heart rate reduction during computed tomography coronary angiography


The aim of the study was to quantify the efficacy of pretreatment with Ivabradine ( Corlentor, Procoralan ) compared to beta-blockers before computed tomography coronary angiography ( CTCA ) via a meta-analysis of clinical randomized controlled trial data.

Researchers have conducted a search for randomized controlled trials of pretreatment with Ivabradine compared to beta-blockers before CTCA,
Eight studies involving a total of 1,324 patients were included in the final analysis.

The results showed that Ivabradine was significantly more effective at improving the heart rate of patients achieving the target heart rate ( less than 65 bpm ) during CTCA ( odds ratio, OR=5.02; 95% CI 3.16-7.98, P less than 0.00001, I2 = 20% ).

A comparison of efficacy between Ivabradine and beta-blockers showed a statistically significant effect of Ivabradine on heart rate reduction during CTCA ( MD -4.39; 95% CI -4.80 to -3.99, P less than 0.00001, I2 = 0% ).

Ivabradine also led to a significant reduction in heart rate prior to CTCA ( MD -5.33; 95% CI -10.26 to -0.39, p = 0.03, I2 = 92% ).

In terms of the total reduction in heart rate during CTCA, significant differences were noted between the Ivabradine group and the beta-blocker group ( MD 2.64; 95% CI 1.25-4.02, p = 0.0002, I2 = 0% ).
The mean percentage reduction in heart rate in the Ivabradine group was significantly higher than that in the beta-blocker group ( MD 7.18; 95% CI 5.64-8.72, P less than 0.00001, I2 = 43% ).

Ivabradine had no significant effect on either systolic blood pressure ( MD 11.41; 95% CI 6.43-16.40, P less than 0.00001, I2 = 85% ) or diastolic blood pressure ( MD 1.79; 95% CI -0.00 to 3.58, P = 0.05, I2 = 56% ).

In conclusion, compared to beta-blockers for heart rate reduction, Ivabradine is a potentially attractive alternative for patients undergoing computed tomography coronary angiography. ( Xagena )

Qiu S et al, Cardiology 2016;135:133-140

XagenaMedicine_2016



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