Qiu Shuang, Shi Shaobo, Ping Haiqin, Zhou Sanfeng, Wang Hui, Yang Bo
Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, and Hubei Key Laboratory of Cardiology, Wuhan, PR China.
Cardiology. 2016;135(3):133-140. doi: 10.1159/000447236. Epub 2016 Jun 22.
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.
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&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.
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%).
Compared to β-blockers for heart rate reduction, ivabradine is a potentially attractive alternative for patients undergoing CTCA.
通过对临床随机对照试验数据进行荟萃分析，量化与β受体阻滞剂相比，伊伐布雷定在计算机断层扫描冠状动脉造影（CTCA）前进行预处理的疗效。
我们在Medline、PubMed、Embase、SCI/SSCI/A&HCI、SAS出版社、科学网和考克兰中央对照试验注册库中搜索了关于伊伐布雷定与β受体阻滞剂在CTCA前进行预处理的随机对照试验。纳入研究的Jadad质量评分以及心率降低的平均差值（MD）是疗效指标。使用RevMan 5.2和Stata 12.0软件进行荟萃分析。
最终分析纳入了8项研究，共1324例患者。结果显示，伊伐布雷定在改善CTCA期间达到目标心率（<65次/分钟）的患者心率方面显著更有效（OR 5.02；95%CI 3.16 - 7.98，p < 0.00001，I² = 20%）。伊伐布雷定与β受体阻滞剂疗效比较显示，伊伐布雷定在CTCA期间对降低心率有统计学显著效果（MD -4.39；95%CI -4.80至 -3.99，p < 0.00001，I² = 0%）。伊伐布雷定还导致CTCA前心率显著降低（MD -5.33；95%CI -10.26至 -0.39，p = 0.03，I² = 92%）。在CTCA期间心率的总降低方面，伊伐布雷定组与β受体阻滞剂组之间存在显著差异（MD 2.64；95%CI 1.25 - 4.02，p = 0.0002，I² = 0%）。伊伐布雷定组心率降低的平均百分比显著高于β受体阻滞剂组（MD 7.18；95%CI 5.64 - 8.72，p < 0.00001，I² = 43%）。伊伐布雷定对收缩压（BP）（MD 11.41；95%CI 6.43 - 16.40，p < 0.00001，I² = 85%）或舒张压（MD 1.79；95%CI -0.00至3.58，p = 0.05，I² = 56%）均无显著影响。
与β受体阻滞剂降低心率相比，伊伐布雷定对于接受CTCA的患者是一种潜在有吸引力的替代药物。
