Heart rate management using ivabradine in acute myocardial infarction: a propensity score-matched single-center study

The therapeutic role of ivabradine in acute myocardial infarction (AMI) remains clinically debated. This study used real-world data to evaluate the rehospitalization risk associated with ivabradine treatment for heart rate control. Among 408 patients with AMI, 76 (18.6%) received ivabradine. Kaplan-Meier analysis, log-rank test, Cox proportional hazards models, and propensity score matching (PSM) were used to assess the rehospitalization risk. Additionally, an interaction test evaluated ivabradine's impact on the rehospitalization risk across relevant risk factors. Multiple imputation was employed to handle missing data. Multivariable Cox regression analysis revealed that ivabradine therapy was associated with a reduced risk of all-cause rehospitalization in patients with AMI before PSM (HR: 0.64; 95% CI: 0.44-0.91, P = 0.015), but not after (HR: 0.79; 95% CI: 0.50-1.24, P = 0.310). Subgroup analysis demonstrated a decreased rehospitalization risk following ivabradine therapy in females (HR: 0.44; 95% CI: 0.22-0.89, P = 0.023), and patients with heart rate > 70 bpm (HR: 0.59; 95% CI: 0.40-0.89, P = 0.011), Killip classification > 1 (HR: 0.62; 95% CI: 0.39-0.99, P = 0.046), anterior wall myocardial infarction (HR: 0.49; 95% CI: 0.26-0.93, P = 0.029), > 1 diseased vessel (HR: 0.59; 95% CI: 0.38-0.93, P = 0.023), and no chronic kidney disease (CKD) (HR: 0.67; 95% CI: 0.46-0.98, P = 0.040) or clopidogrel therapy (HR: 0.54; 95% CI: 0.32-0.90, P = 0.019). Target-range heart rate at first discharge was linked to a lower rehospitalization risk (HR: 0.74; 95% CI: 0.57-0.96, P = 0.025). Multivariable analysis indicated that ivabradine reduced the rehospitalization risk over a 12-month follow-up (adjusted HR: 0.80; 95% CI: 0.66-0.96, P = 0.017). In conclusion, ivabradine therapy during hospitalization was associated with a lower risk of all-cause rehospitalization in patients with AMI. However, the robustness of our findings requires further validation.