Department of Emergency, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
Department of Internal Medicine, Danzhou People's Hospital, Danzhou, China.
Ann Palliat Med. 2021 Apr;10(4):4523-4531. doi: 10.21037/apm-21-563.
Cardiovascular diseases have become a prominent threat to public health and quality of life. In recent years, some studies have reported that ivabradine can improve the cardiac function and prognosis of patients with acute myocardial infarction (AMI).
We searched China National Knowledge Infrastructure (CNKI), Wanfang database, Chinese Biomedical Literature (CBM), Chongqing Weipu Chinese Sci-tech Journal Database (VIP), PubMed, Cochrane Library, and EMBASE for randomized controlled trials (RCTs) of ivabradine in the treatment of AMI from January 1980 until December 2020. Each RCT was systematically reviewed.
A total of 7 RCTs with 658 patients were included. Compared with the control group, the heart rate [mean deviation (MD) =-9.20, 95% confidence interval (CI): -13.03 to -5.38, P<0.00001] and brain natriuretic peptide (BNP) (MD =-112.73, 95% CI: -186.12 to -39.35, P=0.003) of patients who received ivabradine combined with conventional standard treatment were significantly lower and left ventricular ejection fraction (LVEF) (MD =3.17, 95% CI: 2.12 to 4.23, P<0.00001) was significantly better. The difference in adverse events was not statistically significant [odds ratio (OR) =2.45, 95% CI: 0.92 to 6.55, P=0.07].
Ivabradine combined with β-blockers can reduce the resting heart rate and improve heart function in patients with AMI while not increasing adverse events. However, due to limitations in the number and quality of studies included, our conclusions need to be further confirmed by analyzing more studies.
心血管疾病已成为公众健康和生活质量的突出威胁。近年来，一些研究报道伊伐布雷定可改善急性心肌梗死（AMI）患者的心脏功能和预后。
我们检索了中国知网（CNKI）、万方数据库、中国生物医学文献数据库（CBM）、维普中文科技期刊数据库（VIP）、PubMed、Cochrane 图书馆和 EMBASE 自 1980 年 1 月至 2020 年 12 月期间发表的伊伐布雷定治疗 AMI 的随机对照试验（RCT）。对每项 RCT 进行系统评价。
共纳入 7 项 RCT 共计 658 例患者。与对照组相比，接受伊伐布雷定联合常规标准治疗的患者心率[均数差值（MD）=-9.20，95%置信区间（CI）：-13.03 至-5.38，P<0.00001]和脑钠肽（BNP）（MD=-112.73，95%CI：-186.12 至-39.35，P=0.003）明显降低，左心室射血分数（LVEF）（MD=3.17，95%CI：2.12 至 4.23，P<0.00001）明显提高。不良事件的差异无统计学意义[比值比（OR）=2.45，95%CI：0.92 至 6.55，P=0.07]。
伊伐布雷定联合β受体阻滞剂可降低 AMI 患者静息心率，改善心功能，且不增加不良事件。但是，由于纳入研究的数量和质量有限，我们的结论需要通过分析更多的研究来进一步证实。
