PDF(Pubmed)
Abstract：
Heart rate (HR) lowering during acute coronary syndrome (ACS) is beneficial as it reduces myocardial oxygen consumption. However, the role of ivabradine as an HR-lowering agent in the setting of ACS is not clear. We aimed to systematically review and synthesize the current evidence on the role of ivabradine use in the ACS. A systematic review was conducted for eligible randomized clinical trials and quasi-experimental studies, between 2009 and 2020, that investigated the use of ivabradine in ACS. Various clinical endpoints were evaluated such as major adverse cardiovascular events, efficacy in HR control, impact on left ventricular (LV) dimensions and function, and overall safety. Eleven publications were included encompassing a total of 1833 patients. The mean age of the examined cohort was 57 ± 11 years and 80 % were men. Seven studies were in the setting of ST-segment elevation myocardial infarction (MI) while the remaining studies also included patients with unstable angina and non-ST-segment elevation MI. Ivabradine was administered as a peroral drug with dosing from 2.5 to 7.5 mg b.i.d. Overall, the addition of ivabradine was superior to the control arm concerning HR control with a good safety profile. Beneficial effects on LV function and potential impact on infarct size reduction were observed as well. The use of ivabradine appeared to not affect short-term mortality. In conclusion, the use of ivabradine for HR control is safe, feasible, and efficacious for HR control in the ACS. Further studies are required to elucidate other potentially beneficial effects of ivabradine.
摘要：
在急性冠状动脉综合征(ACS)期间降低心率(HR)是有益的,因为其减少心肌耗氧量。然而,伊伐布雷定作为降低HR的药物在ACS患者中的作用尚不清楚.我们旨在系统地回顾和综合目前关于伊伐布雷定在ACS中作用的证据。对符合条件的随机临床试验和准实验研究进行了系统评价，2009年至2020年，调查了伊伐布雷定在ACS中的使用情况。评估各种临床终点，如主要不良心血管事件，在HR控制中的功效，对左心室（LV）尺寸和功能的影响，和整体安全。包括11篇出版物，共1833名患者。受检队列的平均年龄为57±11岁，80%为男性。七项研究是在ST段抬高型心肌梗死（MI）的背景下进行的，而其余研究还包括不稳定型心绞痛和非ST段抬高型MI的患者。伊伐布雷定作为口服药物给药，剂量为2.5至7.5mgb.i.d。在HR控制方面,加用伊伐布雷定优于对照组,安全性良好.还观察到对LV功能的有益影响和对梗死面积减小的潜在影响。伊伐布雷定的使用似乎不影响短期死亡率。总之,使用伊伐布雷定进行HR控制是安全的，可行,对ACS中的HR控制有效。需要进一步的研究来阐明伊伐布雷定的其他潜在有益作用。
