To evaluate whether ivabradine, when added to current guideline-based therapy, improves LV remodelling in STEMI patients treated with PPCI.
This paired-cohort study included 124 patients between June 2011 and July 2012. Ivabradine (5 mg twice daily) was given promptly after PPCI, along with beta-blockers, to obtain a heart rate < 60 beats per minute (ivabradine group). This group was matched with STEMI patients treated in line with current guidelines, including beta-blockers (bisoprolol), according to age, sex, infarct-related coronary artery, ischaemia time and infarct size determined by initial cardiac magnetic resonance imaging (CMR) (control group). Statistical analyses were performed according to an intention-to-continue treatment principle. CMR data at 3 months were available for 122 patients.
Heart rate was lower in the ivabradine group than in the control group during the initial CMR (P = 0.02) and the follow-up CMR (P = 0.006). At the follow-up CMR, there was a smaller increase in LV end-diastolic volume index in the ivabradine group than in the control group (P = 0.04). LV end-systolic volume index remained unchanged in the ivabradine group, but increased in the control group (P = 0.01). There was a significant improvement in LV ejection fraction in the ivabradine group compared with in the control group (P = 0.04).
In successfully reperfused STEMI patients, ivabradine may improve LV remodelling when added to current guideline-based therapy.