الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Despite remarkable therapeutic advances in the management of acute myocardial infarction (AMI) over the last decades, many patients are still at increased risk of adverse cardiac events. The risk is even more in patients with resting heart rate 70 bpm who are at a higher risk for cardiovascular mortality and morbidity.
There is strong evidence on the association between the increased risk of heart attacks, death in patients with CAD and elevated resting heart rate in those patients.
Lowering the resting heart rate in patients with CAD reduces the myocardial oxygen consumption and plays an important role in reducing cardiovascular events.
The objective of our study is to study the effect of adding a pure heart rate lowering agent (Ivabradine) on reduction of major adverse cardiac events (cardiac death, nonfatal myocardial infarction, recurrent symptomatic ischemia, urgent revascularization) in patients with ST elevation myocardial infarction through the first 2 months.
The study started on 1/9/2009 and ended on 1/10/2010 on patients with STEMI who are successfully thrombolysed. The number of patients was 45 patients divided into 3 groups (Group A included patients with STEMI on conventional treatment, group B included patients with STEMI on ivabradine added to conventional treatment and group C included patients with STEMI on ivabradine only without beta blockers).
All the patient enrolled in this study were subjected to:
• Detailed history
• Clinical examination
• Investigations:
o Resting 12 – leads ECG on admission, discharge and during the follow up visits at 2 weeks and 2 months.
o Biochemical markers: troponin (TnI), creatinine kinase (CK) and its isoenzyme MB (CK-MB).
o Resting transthoracic echocardiography to assess the left ventricular systolic function.
Patients taking ivabradine received a starting dose of 5 mg bid which was up-titrated after 2 weeks to 7 mg bid. Follow up was after 2 weeks from admission to evaluate the heart rate and the ECG and after 2 months from admission to assess the heart rate, ECG, left ventricular systolic function by echocardiography and detecting the occurrence of any of the major adverse cardiac events (MACE).
The results of the study showed there was no significant difference in reduction of MACE whether on using ivabradine alone (group C) or adding it to beta blockers (group B).
We concluded that ivabradine may be non inferior to beta blockers in reduction of major adverse cardiac events (MACE) considering its safety, tolerability and cost benefit