The effect of ivabradine on long term prevention of major adverse cardiac events in acute coronary syndrome using high-sensitivity C-reactive protein level

Introduction

C-reactive protein (CRP) value can identify the risk level for acute coronary syndrome (ACS). Ivabradine, a selective inhibitor of the funny current channel, reduces resting and exercise HR without affecting cardiac contractility or blood pressure.

Aim of work

Evaluate the influence of Ivabradine on long term prevention of major adverse cardiac events (MACE) using high sensitivity crp (hs CRP).

Methodology

60 pts were admitted with ACS over the period of 6 months. Cardiac enzymes were withdrawn on admission and every 6 h thereafter for 24 h then followed up daily for five days and when indicated. High sensitivity C-reactive protein (hs-CRP) (quantitative value) which was done on day of admission and repeated for follow up at day 4 and at day 30 patients divided into two groups each 30 pts: group (A) who received conventional therapy & ivabradine, group (B) who received conventional therapy only. Ivabradine given within 48 h of admission 5 mg twice daily upgraded to 7.5 mg twice daily after one week if tolerable Myocardial perfusion imaging (MPI): Patients were subjected to Technetium⁹⁹ sesta MIBI Myocardial perfusion imaging (MPI) within 6–8 h after admission and were followed up on day 30 with the same dose of injection using multi-spect Siemens dual head gamma Camera.

Results

There were significant variances in Hs-CRP value at day 30 in both groups (P value < 0.001). Patients of group A showed statistically significant lower level of hs-CRP at day 30 compared to group B (0.7 ± 0.3 mg/dl versus 1.66 ± 0.9 mg/dl; P value < 0.001) but there was no statistically significant difference between both groups regarding 30 days follow up MACE (P value 0.552).

Conclusion

Administration of ivabradine within 48 h of CCU admission decreased hs-CRP level in patients with acute coronary syndrome (unstable angina) but did not decrease the occurrence of major cardiac events in ACS patients.