Key result
Ivabradine yields ~5-fold higher odds of achieving target heart rate during CTCA versus beta-blockers.
Why the study?
The comparative efficacy of ivabradine versus β-blockers for heart rate reduction before computed tomography coronary angiography was not well quantified.
Does pretreatment with ivabradine improve heart rate reduction compared to β-blockers in patients undergoing computed tomography coronary angiography?
Meta-Analysis (n=1,324)
Does pretreatment with ivabradine improve heart rate reduction compared to β-blockers in patients undergoing computed tomography coronary angiography?
Pretreatment with ivabradine is significantly more effective than β-blockers for achieving target heart rate reduction prior to computed tomography coronary angiography.
Answers are grounded in this paper and cite their sources.
Ivabradine yields superior HR reduction versus β-blockers pre-CTCA; confirms pooled RCT superiority for target-rate achievement.
OBJECTIVE: To quantify the efficacy of pretreatment with ivabradine compared to β-blockers before computed tomography coronary angiography (CTCA) via a meta-analysis of clinical randomized controlled trial data. METHODS: We conducted a search for randomized controlled trials of pretreatment with ivabradine compared to β-blockers before CTCA in Medline, PubMed, Embase, SCI/SSCI/A&HCI, SAS Publishers, Web of Science, and the Cochrane Central Register. The Jadad quality score of the included studies, and the mean difference (MD) in heart rate reduction, were indicators of efficacy. RevMan 5.2 and Stata 12.0 software were used for the meta-analysis. RESULTS: Eight studies involving a total of 1,324 patients were included in the final analysis. The results showed that ivabradine was significantly more effective at improving the heart rate of patients achieving the target heart rate (<65 bpm) during CTCA (OR 5.02; 95% CI 3.16-7.98, p < 0.00001, I2 = 20%). A comparison of efficacy between ivabradine and β-blockers showed a statistically significant effect of ivabradine on heart rate reduction during CTCA (MD -4.39; 95% CI -4.80 to -3.99, p < 0.00001, I2 = 0%). Ivabradine also led to a significant reduction in heart rate prior to CTCA (MD -5.33; 95% CI -10.26 to -0.39, p = 0.03, I2 = 92%). In terms of the total reduction in heart rate during CTCA, significant differences were noted between the ivabradine group and the β-blocker group (MD 2.64; 95% CI 1.25-4.02, p = 0.0002, I2 = 0%). The mean percentage reduction in heart rate in the ivabradine group was significantly higher than that in the β-blocker group (MD 7.18; 95% CI 5.64-8.72, p < 0.00001, I2 = 43%). Ivabradine had no significant effect on either systolic blood pressure (BP) (MD 11.41; 95% CI 6.43-16.40, p < 0.00001, I2 = 85%) or diastolic BP (MD 1.79; 95% CI -0.00 to 3.58, p = 0.05, I2 = 56%). CONCLUSION: Compared to β-blockers for heart rate reduction, ivabradine is a potentially attractive alternative for patients undergoing CTCA.
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Qiu et al. (2016) conducted a meta-analysis in Patients undergoing computed tomography coronary angiography (CTCA) (n=1,324). Ivabradine vs. β-blockers was evaluated on Achieving the target heart rate (<65 bpm) during CTCA (OR 5.02, 95% CI 3.16-7.98, p=<0.00001). Pretreatment with ivabradine was more effective than β-blockers at achieving a target heart rate <65 bpm during computed tomography coronary angiography.
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