Long-term effects of metoprolol and ivabradine in reperfused anterior myocardial infarction: met-iva study (clinical findings after 8 years of follow-up)
International Journal of Development Research
Long-term effects of metoprolol and ivabradine in reperfused anterior myocardial infarction: met-iva study (clinical findings after 8 years of follow-up)
Received 20th December, 2017; Received in revised form 02th January, 2018; Accepted 19th February, 2018; Published online 30th March, 2018
Copyright © 2018, Sergio Fasullo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Heart rate is a determinant of myocardial oxygen demand and in myocardial infarction it is related to mortality. Ivabradine is a pure cardiac agent that reduces speed and has no effect on blood pressure and contractility and can reverse left ventricular remodeling. B-blockers in ST-elevated myocardial infarction (STEMI) are indicated for patients without a contraindication, particularly in patients with high heart rate or blood pressure. Epidemiological studies have shown that the increase in CF represents a risk factor for cardiovascular morbidity. Aim of the study: The aim of this work is to evaluate the effects of ivabradine versus metoprolol in reperfused anterior STEMI after 8 years of follow up, the our primary end point was to analyze the quality of life during the 8 years of follow up. Methods: In this prospective study, comparison between baseline and follow-up IVA (ivabradine) and METO (metoprolol) data was performed for patients with successful PCI for anterior STEMI with an impaired left ventricular function and high HR and sinus rhythm. The discharged reperfused anterior STEMI (PCI-Treated) patients were followed and they carried out periodical controls in our department to analyze the incidence of ischemic events and other problems and further the patients were undergone to questionnaire on quality of life (EQ-5D-5L). Clinical and echocardiographic data were also were analyzed. Results: At baseline in the study group, HR was significantly reduced in both groups, the IVA group showed a significant increase in EF (51.92 +\- 5.94 vs 44.5 +\- 4.44, p<0,001), but all parameters remained unchanged after 8 years (ex: HR: 66.42 +\- 4.46 vs 66.09 +\- 4.50; p>0,743). Most of IVA group have reported a good quality of life related to health in comparison with metoprolol group. The EQ-VAS Score for IVA group is 1.3 points higher than the average EQ-VAS score for METO group. Conclusions: This study shows not only that ivabradine improves LV remodelling after AMI when added to current guideline-based therapy, in STEMI patients treated with successful PCI, but shows mostly that the beneficial effects were continued during the subsequent 8 years, showing IVA group a significant reduction in LVEDV and LVESV indexes compared with the METO group after 8 years, as well as a better quality of life.
