Ivabradine In The Treatment For Stable Angina Pectoris:A Meta-analysis

Objective:The meta-analysis of this study was to evaluated the efficacy and safety of ivabradine versus beta-blockers in the treatment for stable angina pectoris.Subjects and methods:The randomized controlled trials of ivabradine versus beta-blocker in the treatment of stable angina pectoris were searched from Cochrane Central Register of Controlled Trials,Pub Med,EMb ase,CNKI,CBM,VIP database of Chinese journal and Wan-fang database.Retrieve the time from inception to May 1,2017.According to predefined inclusion and exclusion criteria,these screened relevant studies were evaluated the quality and performed meta-analyses by using Rev Man 5.3 software.Results:7 domestic and foreign randomized controlled clinical trials,including 3153 patients who were divided by using ivabradine or beta-bl ocker into two groups,1742 patients in the treatment group(ivabradine gr oup),and 1411 patients in the control group(beta-blocker group),were e nrolled in the review.After 12 weeks,compared to the control group,t he results of meta-analysis showed that treatment group can significantly decrease heart rate at rest(b.p.m.),time to angina onset(s),weekly num ber of angina attacks(WMD=5.11,95%CI(2.96,7.26),P<0.00001;WM D=23.83,95%CI(13.95,33.71),P<0.00001;WMD=0.13,95%CI(0.02,0.25),P=0.02)and increase total exercise duration(s),incidence of side eff ects,especially paropsia(WMD=13.89,95%CI(0.52,27.25),P=0.04;RR=2.97,95%CI(1.23,7.19),P=0.02;RR=3.02,95%CI(1.49,6.11),P=0.002).There were no differences in RPP at peak exercise(b.p.m.*mm Hg),tim e to 1 mm ST depression(s),incidence of side effects,such as sinus br adycardia,headache and dizziness and gastrointestinal symptoms(SMD=-0.04,95%CI(-0.74,0.65),P=0.90;WMD=12.22,95%CI(-14.75,39.19),P=0.37;RR=1.73,95%CI(0.63,4.78),P=0.29;RR=1.32,95%CI(0.38,4.53),P=0.66;RR=2.58,95%CI(0.61,10.98),P=0.2).After 4 weeks,the diffe rences between treatment group and control group in heart rate at peak exercise(b.p.m.)have no statistical significance(WMD=4.49,95%CI(-0.14,9.11),P=0.06).Conclusion:Ivabradine was not inferior to beta-blocker in clinical efficacy especially resting heart rate of the treatment for stable angina pectoris.However,the long-term efficacy and safety will be still required to confirm by using randomized,double-blind,controlled Trials.