Key result
Ivabradine fails to reduce cardiovascular mortality in patients with chronic stable angina.
Why the study?
Ivabradine serves as second-line medication for CAD-related angina pectoris, prompting this assessment of the existing evidence of ivabradine in angina pectoris.
Does ivabradine improve symptoms and clinical outcomes in patients with chronic stable angina pectoris compared to placebo, standard therapy, or other anti-anginal drugs?
Meta-Analysis (n=16,039)
Does ivabradine improve symptoms and clinical outcomes in patients with chronic stable angina pectoris compared to placebo, standard therapy, or other anti-anginal drugs?
Hazard Ratio: 1.1 (95% CI 0.94–1.28)
p-value: p=0.25
This meta-analysis reveals a lack of convincing evidence for significant advantages of ivabradine over other anti-anginal therapies in chronic stable angina, highlighting the need for selective use rather than broad application.
No CV mortality benefit with ivabradine in stable angina; cautions against routine use and confirms neutral hard outcomes.
Background and Objectives Coronary artery disease (CAD) is the number one cause of death worldwide. The If 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. Methods 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. Results 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). Conclusions 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.
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Kalvelage et al. (2020) conducted a meta-analysis in Chronic stable angina pectoris (n=16,039). Ivabradine vs. Placebo, standard therapy, or other anti-anginal drugs (atenolol, ranolazine) was evaluated on Cardiovascular mortality (HR 1.10, 95% CI 0.94-1.28, p=0.25). Ivabradine did not significantly reduce cardiovascular mortality compared to placebo or standard therapy in patients with chronic stable angina pectoris (HR 1.10).
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