Long-term safety and efficacy of ivabradine after direct percutaneous coronary intervention in patients with acute myocardial infarction complicated by heart failure: a single-center retrospective study

BACKGROUND: There are few studies on the long-term efficacy and safety of ivabradine in patients with acute myocardial infarction (AMI) complicated by heart failure. We aimed to assess the above questions and provide clinical experience. METHODS: The study enrolled patients with AMI complicated by heart failure who underwent percutaneous coronary intervention (PCI) from January 2022 to June 2023. Based on the discharge medications, patients were stratified into two groups: (1) the ivabradine group (receiving ivabradine with or without β-blockers) and (2) the β-blocker monotherapy group (control). Efficacy effects included in-hospital heart rate control, all-cause mortality, and heart failure readmission. Safety effects comprised recurrent myocardial infarction and recurrent angina rehospitalization. The initial cohort comprised 517 patients, excluding 62 who discontinued ivabradine, leaving 455 for analysis (ivabradine group: n = 101; β-blocker group: n = 354). Following 1:1 propensity score matching (PSM), 92 matched pairs were available for analysis. Potential confounding variables were adjusted through robust Cox proportional hazards regression modeling. RESULTS: Post-treatment, heart rate at discharge significantly decreased in both groups, with the ivabradine group demonstrating lower values than the β-blocker group (P < 0.05). At 2-year follow-up (post- PSM), the ivabradine group showed a reduced risk of heart failure readmission compared to the β-blocker group (hazard ratio [HR]: 0.32; 95% confidence interval [CI]: 0.13-0.77; P = 0.012). However, no significant intergroup difference was observed in all-cause mortality (HR: 1.04; 95% CI: 0.41-2.61; P = 0.937). No significant differences were observed between the two groups in the safety endpoints, including recurrent myocardial infarction or rehospitalization for angina. CONCLUSION: Early administration of ivabradine following PCI in patients with AMI complicated by heart failure can lower resting heart rate and is beneficial in reducing the risk of rehospitalization for heart failure. However, these findings support further investigation in future large prospective studies. CLINICAL TRIAL NUMBER: Not applicable.