A Pilot Study Evaluating the Effect of Ivabradine on Inflammation and Short-term Clinical Outcome of Patients with Acute Coronary Syndrome

Abstract

Background: There is a strong association between elevated heart rate (HR), systemic inflammation and atherosclerosis.We assumed that HR lowering by ivabradine might decrease inflammation in patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS). Objective: Study the effects of ivabradine add on treatment on high sensitivity C-reactive protein (hsCRP) levels in patients with NSTE-ACS. Methods:The current prospective, randomized, controlled, study recruited NSTE-ACS patients with HR ≥70 beats per minutes (bpm). Each patient was randomly assigned to either control or ivabradine groups. The difference between the two groups was the addition of ivabradine (up to 7.5 mg bid) to the standard treatment of NSTE-ACS patients for 30 days in the ivabradine group. Levels of hsCRP were evaluated before and after the study period. The primary outcome was the difference between the two groups in hsCRP reduction. Results:Forty five patients were enrolled; twenty three of them received ivabradine. The decrease (%) in HR after treatment was significantly higher in ivabradine group than in control group(23.8 (7.3 – 31) % vs 4.7 (0 - 22.5) %, p = 0.014). The decrease in HR was positively correlated to hsCRP reduction, r = 0.445, p = 0.003. No significant difference between ivabradine and control groups in hsCRP reduction (80 (38 - 90.6) % vs 61.3 (24 - 76.4) %, P = 0.057). Ivabradine was well-tolerated. Conclusion:Ivabradine effectively and safely decreased HR in NSTE-ACS patients. Reduction in HR was associated with hsCRP reduction.Larger studies are required to better demonstrate the anti-inflammatory effects of ivabradine in ACS.