A CLINICAL STUDY EVALUATING THE EFFECT OF IVABRADINE ON INFLAMMATION IN PATIENTS WITH NON ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES

There is a strong association between elevated heart rate (HR), systemic inflammation and atherosclerosis. We assumed that HR lowering by ivabradine might decrease inflammation in patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS). Objective: Study the effects of ivabradine add on treatment on High sensitivity C-reactive protein (hsCRP) levels in patients with NSTE-ACS. Methods: This prospective, randomized, controlled, study recruited NSTE-ACS patients with HR ≥70beats per minutes. Each patient was randomly assigned to either control or ivabradine groups. The difference between the two groups was the addition of ivabradine (up to 7.5 mg bid) to the standard treatment of NSTE-ACS patients for 30 days in the ivabradine group. Levels of hsCRP were evaluated before and after the study period. The primary outcome was the difference between the two groups inhsCRP reduction. Results: We enrolled 45 patients, twenty three of which received ivabradine. The decrease (%) in HR after treatment was significantly larger inivabradine group than in control group (23.8 (7.3 – 31) vs 4.7 (0 – 22.5) %, p = 0.014). The decrease in HR was positively correlated to hsCRP reduction, r = 0.445, p = 0.003. No significant difference between ivabradine and control groups in hsCRP reduction (80 (38 – 90.6) vs 61.3 (24 – 76.4) %, P = 0.057). Ivabradine was well-tolerated. Conclusion: Ivabradine effectively and safely decreased HR in NSTE-ACS patients. Reduction in HR was associated with hsCRP reduction. Larger studies are required to better demonstrate the anti-inflammatory effects of ivabradine in ACS.