Efficacy of Ivabradine versus β-Blockers for Heart Rate Reduction during Computed Tomography Coronary Angiography: A Meta-Analysis of Randomized Controlled Trials.
OBJECTIVE
To quantify the efficacy of pretreatment with ivabradine compared to β-blockers before computed tomography coronary angiography (CTCA) via a meta-analysis of clinical randomized controlled trial data.


METHODS
We conducted a search for randomized controlled trials of pretreatment with ivabradine compared to β-blockers before CTCA in Medline, PubMed, Embase, SCI/SSCI/A&amp;HCI, SAS Publishers, Web of Science, and the Cochrane Central Register. The Jadad quality score of the included studies, and the mean difference (MD) in heart rate reduction, were indicators of efficacy. RevMan 5.2 and Stata 12.0 software were used for the meta-analysis.


RESULTS
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 (<65 bpm) during CTCA (OR 5.02; 95% CI 3.16-7.98, p < 0.00001, I2 = 20%). A comparison of efficacy between ivabradine and β-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 < 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 β-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 β-blocker group (MD 7.18; 95% CI 5.64-8.72, p < 0.00001, I2 = 43%). Ivabradine had no significant effect on either systolic blood pressure (BP) (MD 11.41; 95% CI 6.43-16.40, p < 0.00001, I2 = 85%) or diastolic BP (MD 1.79; 95% CI -0.00 to 3.58, p = 0.05, I2 = 56%).


CONCLUSIONS
Compared to β-blockers for heart rate reduction, ivabradine is a potentially attractive alternative for patients undergoing CTCA.
Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, and Hubei Key Laboratory of Cardiology, Wuhan, PR China.
Shuang
S
Qiu
Shaobo
S
Shi
Haiqin
H
Ping
Sanfeng
S
Zhou
Hui
H
Wang
Bo
B
Yang
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D001552:Benzazepines / Q000494:pharmacology*; D002317:Cardiovascular Agents / Q000494:pharmacology*; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D000077550:Ivabradine; D016032:Randomized Controlled Trials as Topic
D000319:Adrenergic beta-Antagonists; D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine