Abstract P184: Cardioprotective Effects Of Ivabradine After Coronary Revascularization: A Systematic Review

Abstract

Background: The perioperative management of cardiac risk for patients undergoing coronary revascularization has mostly centered around beta-blockers (BB). Ivabradine is a much newer drug that has been approved for stable angina and heart failure not fully controlled by BB. Emerging evidence suggests that it may have cardioprotective effects in high-risk cardiac patients. The objective of this study was to summarize the evidence on the use and effects of ivabradine in coronary revascularization patients. Methods: We performed a systematic review using the PubMed, EMBASE, and Google Scholar databases for studies published between 2010 and 2020. Two independent investigators reviewed studies reporting information on ivabradine use following coronary revascularization. We excluded articles written in languages other than English. Results: Eleven studies met our inclusion criteria, including a total of 3,847 patients (1994 with percutaneous coronary intervention [51.8%], 1680 with coronary artery bypass graft [43.7%], and 173 with other type of intervention [4.5%]). The studies were from seven different countries: Egypt, France, Germany, Greece, Italy, Romania, and Spain. The mean age ranged from 56.5 to 74.3. Males accounted for 70.9% of the patients, resulting in an M:F ratio of 1.4:1. For studies that compared the use of ivabradine to placebo/control, the latter being defined as standard medical therapy that either did or did not include BB, the results showed that the use of ivabradine resulted in significant reduction of heart rate, decreased number of angina attacks, lower nitrate consumption, improvement in quality of life, and increased cardiac index. Studies that compared the effects of ivabradine monotherapy to BB monotherapy showed that the former was associated with a higher rate of atrial fibrillation, but an overall better quality of life as measured by the EuroQol questionnaire. When combined therapy with ivabradine and BB was compared to BB monotherapy, the former was associated with a significant increase in diastolic function, improvement in left ventricular ejection fraction, and a decrease in incidence of arrhythmias. Eight of the eleven studies reported adverse events related to ivabradine use, the most frequent being bradycardia (range: 0 to 7.1%), phosphenes (range: 0 to 0.3%), and blurred vision (range: 0 to 0.2%). Conclusions: This study demonstrates that ivabradine may be used alone or in addition to BB to reduce adverse cardiac events and improve the quality of life in patients undergoing coronary revascularization. However, there is no evidence that ivabradine is superior to BB when used alone. Further studies are needed to determine the optimal medical management for patients undergoing coronary revascularization.