Reply to letter “Beta-blockers in acute coronary syndrome patients: The concept of ‘gradient of benefit”’

Introduction: Acute coronary syndrome remains as one of the most important causes for morbidity and mortality in developed countries. Therefore, evidence-based management strategy is required to offset the loss of health during an acute coronary syndrome. An effective approach includes both medical and surgical methods. This study was conducted to evaluate the medical method of management. Objective: To study blood pressure and heart rate variability after administration of Ivabradine or metoprolol in cases with acute coronary syndrome. Materials and methods: The study was a Prospective single center observational study conducted in patients attending Cardiology Intensive Care Unit in Nayyar Heart and Superspecialty Hospital, a tertiary care centre located in an urban area. All patients with Acute coronary syndrome admitted to the emergency or cardiac care unit were analysed with ECG as a preliminary diagnostic test and confirmed with troponin markers. They were either given Ivabradine or Metoprolol. Baseline evaluation and follow up was done and necessary data was collected and analysed. Results: 100 patients were included in the study out of which 50 were given Metoprolol (Group A) and 50 were given Ivabradine (Group B). Themean age of studied cases was found to be 66.54 years in group A and 68.69 years in group B. It was observed that there was a fall in heart rate by 26.8 beats per minute with beta blocker and 24.4 beats per minute with Ivabradine. In case of blood pressure measurement, in patients with beta blocker administration, there was a fall of 25 mm Hg in systolic blood pressure and 17 mm Hg in diastolic blood pressure However, with Ivabradine there was only a fall of 8mm Hg in systolic Blood pressure and 6 mm Hg in diastolic blood pressure. Conclusion: Although Metoprolol is the drug of choice to decrease heart rate and blood pressure in acute coronary syndrome, Ivabradine is being increasingly used in cases where beta blockers are contraindicated as it has similar efficacy in lowering heart rate without compromising contractility of cardiac muscle, thereby maintaining LVEF and blood pressure. Keywords: Acute coronary syndrome, Beta Blockers, Metoprolol, Ivabradine.

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Abstract P331: Secondary Prevention After Acute Coronary Syndrome with Microsize Myocardial Infarctions in the Reasons for Geographic and Racial Differences in Stroke-Myocardial Infarction (REGARDS-MI) Study

Circulation ◽

10.1161/circ.125.suppl_10.ap331 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Niket Nathani ◽

Monika M Safford ◽

Christopher Gamboa ◽

Mallika Mundkur ◽

Shannon Preston ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Secondary Prevention ◽

Racial Differences ◽

Cardiac Troponin ◽

Beta Blockers ◽

Community Dwelling ◽

Prevention Measures ◽

Coronary Syndrome ◽

Similar Range

Background: Studies have shown increased mortality after myocardial infarction (MI) with low level elevations of cardiac troponin (“microsize MI”) and subsequent risk reduction with intensive medical management. However, non-standard reporting and highly sensitive assays of cardiac troponin can make the clinical recognition of microsize MI difficult, creating barriers to the implementation of appropriate secondary prevention. Methods: REGARDS follows 30,239 community-dwelling participants of the 48 continental states age ≥45 years recruited from 2003-7; 41% of the sample was African American and 55% female by design. Following national consensus guidelines, experts adjudicated cases of acute coronary syndrome (ACS), defined as an admission for acute signs or symptoms of ischemia, and MI from hospital records. We studied first cases of ACS, classified as: 1) ACS without MI, 2) ACS+microsize MI (peak troponin <0.5), and 3) ACS+usual MI (peak troponin ≥0.5), to compare whether secondary prevention medications were prescribed at hospital discharge among these 3 groups. We used multivariable logistic regression to examine odds ratios for receipt of medications at discharge associated with microsize MI and no MI relative to usual MI. Results: The 1,238 cases of ACS were mean age 68.0+/-8.7 years, 59% male, and 66% white. Of these, 917 had discharge medications available. Compared to those with ACS+usual MI, individuals with ACS+microsize MI had lower odds of receiving beta-blockers and statins at discharge in a similar range as those without MI ( Table ). Conclusion: Individuals hospitalized for ACS and microsize MI were less likely to receive guideline appropriate secondary prevention measures than those with usual MI.

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4058Effects of selective and nonselective beta-blockers on platelet aggregation in patients with acute coronary syndrome: the PLATE-BLOCK study

European Heart Journal ◽

10.1093/eurheartj/ehy563.4058 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

F Ilardi ◽

G Gargiulo ◽

G G Schiattarella ◽

G Giugliano ◽

R Paolillo ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Platelet Aggregation ◽

Beta Blockers ◽

Coronary Syndrome

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A PROSPECTIVE CONSIDERATIONS AND COMPARATIVE EFFICACY BETWEEN IVABRADINE VS BETA BLOCKERS IN SOUTH INDIAN ACUTE CORONARY SYNDROME PATIENTS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i1.34480 ◽

2019 ◽

pp. 193-195

Author(s):

Hemanth Kumar Lekkala

Keyword(s):

Heart Rate ◽

Acute Coronary Syndrome ◽

Beta Blockers ◽

Statistical Significance ◽

Reduced Ejection Fraction ◽

Coronary Syndrome ◽

Nyha Classification ◽

South Indian ◽

Group A ◽

Group B

Objectives: the objective of this study was to assess the role of heart rate in acute coronary syndrome with reduced ejection fraction, to assess contraindications for beta blockers, to assess the tolerability between Ivabradine and Beta-Blockers, to assess efficacy between Ivabradine and Beta Blockers, to assess patient condition according to NYHA classification. Methods: A Prospective observational study was conducted for a duration of6 months Study population includes 100 patients in which Group A-50, Group B-50. We were selected the subjects according to inclusion and exclusion criteria. The patients were classified in one of four categories based on their symptoms in regards to normal breathing and varying degrees in shortness of breath by using (The New York Heart Association) NYHA Classification. Results: Majority of the patients were in age group between (55-64)(32%) years of age are highly affected with ACS. Prevalence of ACS is high in Rural (56%). Both drugs decreased the mean heart rate to 89.97±10.27 (Group-A) versus 86.76±13.14 (Group-B) beats per minute (P=0.24). The result obtained are clinically and statistically significant with statistical significance at P>0.05. Conclusion: In the present study we considered and compared the efficacy between Ivabradine and Beta Blockers in south Indian acute coronary syndrome patients shows Ivabradine is as effective as betablockers in reduction of heart rate.

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BETA BLOCKERS IN PATIENTS WITH ACUTE CORONARY SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS IN THE REPERFUSION ERA

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2020.07.027 ◽

2020 ◽

Vol 36 (10) ◽

pp. S6-S7

Author(s):

N. Zamiri ◽

H. Alraddadi ◽

T. Adli ◽

S. Jolly ◽

C. Ainsworth ◽

...

Keyword(s):

Systematic Review ◽

Acute Coronary Syndrome ◽

Randomized Trials ◽

Beta Blockers ◽

Meta Analysis ◽

Coronary Syndrome

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Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872616672077 ◽

2016 ◽

Vol 7 (2) ◽

pp. 149-157 ◽

Cited By ~ 7

Author(s):

Magnus T Jensen ◽

Marta Pereira ◽

Carla Araujo ◽

Anti Malmivaara ◽

Jean Ferrieres ◽

...

Keyword(s):

Heart Rate ◽

Acute Coronary Syndrome ◽

Hospital Mortality ◽

Beta Blockers ◽

Heart Rates ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Coronary Syndromes ◽

The Relationship

Aims: The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods: Consecutive ACS patients admitted in 2008–2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. Results: In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70–79 bpm in STEMI and 60–69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Conclusion: Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

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