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Ivabradine in Patients with ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: A Preliminary Randomized Prospective Study

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Abstract

Background and objective

An elevated heart rate (HR) is an independent risk factor for mortality and morbidity in patients with acute heart failure (HF). The purpose of this study was to evaluate the impact of ivabradine, a selective HR-lowering agent, in patients with cardiogenic shock (CS) complicating ST-elevation acute myocardial infarction (AMI).

Methods

Patients with post-AMI CS were randomized to standard treatment (SDT, 28 patients) or to standard treatment plus ivabradine (I + SDT, 30 patients). In the presence of orotracheal intubation (OTI), ivabradine was administered by nasogastric intubation. HR, BP, New York Heart Association (NYHA) class, NT-proBNP, left ventricular ejection fraction (LVEF) and diastolic function (LVDF) were monitored at specific times after the onset of AMI. The primary (surrogate) end-point was the in-hospital halving of plasma NT-proBNP levels. The secondary end-points were cardiovascular death, hospital re-admission for worsening HF, and clinical and haemodynamic improvement.

Results

Treatment groups were statistically similar with regard to age, gender distribution, cardiovascular risk factors, number of diseased vessels and overall treated lesions, AMI site and occurrence of OTI. In-hospital mortality was double in the SDT group in comparison with the I + SDT group (14.3 vs. 6.7 %), but the difference was not statistically significant. HR, BP, NT-proBNP and LVEF favorably changed in both groups, but the change was more relevant in the I + SDT group. LVDF significantly changed only in the I + SDT group (p < 0.01). Patients in the I + SDT group did not experience adverse effects.

Conclusion

Ivabradine in CS complicating AMI is safe, is associated with a short-term favourable outcome and can be effectively administered by nasogastric intubation.

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Authors and Affiliations

  1. Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy

    Francesco Barillà, Giuseppe Pannarale, Concetta Torromeo, Vincenzo Paravati, Maria Cristina Acconcia, Gaetano Tanzilli, Enrico Mangieri, Tania Dominici, Gaetano Pannitteri & Carlo Gaudio

  2. Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Rome, Italy

    Francesco Martino

  3. Cardiac Intensive Care Unit “B”, Dipartimento Cuore e Grossi Vasi “Attilio Reale”, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Francesco Barillà

Authors
  1. Francesco Barillà
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  2. Giuseppe Pannarale
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  3. Concetta Torromeo
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  4. Vincenzo Paravati
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  5. Maria Cristina Acconcia
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  6. Gaetano Tanzilli
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  7. Enrico Mangieri
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  8. Tania Dominici
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  9. Francesco Martino
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  10. Gaetano Pannitteri
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  11. Carlo Gaudio
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Corresponding author

Correspondence to Francesco Barillà.

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Funding

There were no external sources of funding for this study.

Conflict of interest

Francesco Barillà, Giuseppe Pannarale, Concetta Torromeo, Vincenzo Paravati, Maria Cristina Acconcia, Gaetano Tanzilli, Enrico Mangieri, Tania Dominici, Francesco Martino, Gaetano Pannitteri and Carlo Gaudio have no conflicts of interest.

Ethical approval

All procedures in this study were carried out in accordance with the 1964 Declaration of Helsinki and its amendments. The University Hospital Ethics Committee approved the study.

Informed consent

Written informed consent was obtained from all patients or relatives.

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Barillà, F., Pannarale, G., Torromeo, C. et al. Ivabradine in Patients with ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: A Preliminary Randomized Prospective Study. Clin Drug Investig 36, 849–856 (2016). https://doi.org/10.1007/s40261-016-0424-9

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  • DOI: https://doi.org/10.1007/s40261-016-0424-9

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