Kalvelage Christina, Stoppe Christian, Marx Nikolaus, Marx Gernot, Benstoem Carina
Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Cardiovascular Critical Care & Anesthesia Research and Evaluation (3CARE), Medical Faculty, RWTH Aachen University, Aachen, Germany.
Korean Circ J. 2020 Sep;50(9):773-786. doi: 10.4070/kcj.2020.0031. Epub 2020 May 20.
Coronary artery disease (CAD) is the number one cause of death worldwide. The I channel inhibitor ivabradine serves as second line medication for the CAD leading symptom angina pectoris. This systematic review and meta-analysis assess the existing evidence of ivabradine in angina pectoris.
We systematically searched MEDLINE, Embase, CENTRAL, and Web of Science (September 2019) for randomized controlled trials (RCTs) that compared ivabradine versus placebo, standard therapy (ST) or other anti-anginal drugs. Two review authors independently assessed trials for inclusion and performed data extraction. We completed a 'risk of bias' assessment for all studies and assessed quality of the trial evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology. We meta-analysed data were applicable and calculated mean differences (MDs) and risk ratios using a random-effects model.
A total of 11 RCTs (n=16,039) were included. Compared to placebo/ST, we found significant effects on the frequency of hospitalisation in a small cohort (n=90; hazard ratio [HR], 0.19; 95% confidence interval [CI], 0.04, -0.92; p=0.04), but no effects on cardiovascular mortality (n=19,102; HR, 1.10; 95% CI, 0.94, 1.28; p=0.25) or the frequency of angina pectoris episodes (n=167; weighted MD, -1.06; 95% CI, -2.74, -0.61; p=0.21).
The present work makes an important contribution to optimal patient care in angina pectoris by complementing the current European Society of Cardiology guideline-recommending class IIa with evidence level B-decisively with 8 further studies.
冠状动脉疾病（CAD）是全球首要死因。I通道抑制剂伊伐布雷定是CAD主要症状心绞痛的二线用药。本系统评价和荟萃分析评估伊伐布雷定治疗心绞痛的现有证据。
我们系统检索了MEDLINE、Embase、CENTRAL和科学网（2019年9月），以查找比较伊伐布雷定与安慰剂、标准治疗（ST）或其他抗心绞痛药物的随机对照试验（RCT）。两名综述作者独立评估试验是否纳入并进行数据提取。我们对所有研究完成了“偏倚风险”评估，并使用推荐分级评估、制定和评价方法评估试验证据的质量。我们对适用的数据进行荟萃分析，并使用随机效应模型计算平均差（MDs）和风险比。
共纳入11项RCT（n=16,039）。与安慰剂/ST相比，我们发现对一小队列（n=90；风险比[HR]，0.19；95%置信区间[CI]，0.04，-0.92；p=0.04）的住院频率有显著影响，但对心血管死亡率（n=19,102；HR，1.10；95%CI，0.94，1.28；p=0.25）或心绞痛发作频率（n=167；加权MD，-1.06；95%CI，-2.74，-0.61；p=0.21）无影响。
本研究通过补充当前欧洲心脏病学会指南——推荐IIa类、证据水平为B级——并果断增加8项进一步研究，为心绞痛的最佳患者护理做出了重要贡献。
