A comparative study on efficacy of metoprolol and ivabradine in acute ST elevation myocardial infarction patients

Rajashekar Reddy Gurrala, Vinod K. Unni, Parvaiz Kadloor, T. K. Mohammed Rayees, Syed Azeemuddin Razvi, Syeda Uzma, Mehruq Fatima


Background: The ST-elevation myocardial infarction (STEMI), a fatal disease, is rapidly extending in patients, worldwide. Therefore, proper and timely diagnosis followed by appropriate management becomes necessary. The study aimed to compare the effectiveness of metoprolol and ivabradine in acute STEMI patients.

Methods: This was an observational, comparative, in-hospital study carried out in patients admitted in the in-patient cardiac department, intensive cardiac care unit of a tertiary care centre in India. Total 60 patients diagnosed with acute ST-elevation MI were included in the study and were equally divided into two groups. Group 1 involved patients who were given metoprolol for treatment and group 2 involved patients who were given ivabradine. The patients were assessed in terms of heart rate, NYHA class, and ejection fraction. Follow-up of 30 days was taken in all patients.

Results: Ivabradine reduced mean heart rate from 85.57 bpm at baseline to 78.23 bpm. Heart rate in the metoprolol group was reduced from 81.93 bpm to 76.47 bpm over the same time period. Metoprolol and ivabradine showed significant improvement in the ejection fraction volume during the in-hospitalization stay. Ivabradine showed a better improvement in ejection fraction when compared to metoprolol but the difference was not found to be statistically significant. Higher mortality was assessed in ivabradine group compared to metoprolol.

Conclusions: The study gives the gold standard efficacy and mortality benefit of metoprolol, although ivabradine on the other hand gave better responses in heart rate reduction and improvements in ejection fraction.


Ejection fraction, Ivabradine, Metoprolol, ST-elevation myocardial infarction

Full Text:



Helms RA, Quan DJ. Textbook of therapeutics: drug and disease management: Lippincott Williams and Wilkins; 2006.

Fasullo S, Cannizzaro S, Maringhini G, Ganci F, Giambanco F, Vitale G, et al. Comparison of ivabradine versus metoprolol in early phases of reperfused anterior myocardial infarction with impaired left ventricular function: preliminary findings. J Cardiac Failure. 2009;15(10):856-63.

Liang M, Puri A, Devlin G. Heart rate and cardiovascular disease: an alternative to beta blockers. Cardiol Res Practice. 2009;2009.

O'gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):485-510.

Camm AJ, Lau C-P. Electrophysiological effects of a single intravenous administration of ivabradine (S 16257) in adult patients with normal baseline electrophysiology. Drugs R & D. 2003;4(2):83-9.

DiFrancesco D, Camm JA. Heart rate lowering by specific and selective I f current inhibition with ivabradine. Drugs. 2004;64(16):1757-65.

Maxwell S, Waring WS. Therapeutics Drugs used in secondary prevention after myocardial infarction: Case presentation. Br J Clin Pharmacol. 2000;50(5):405-17.

De Ferrari GM, Mazzuero A, Agnesina L, Bertoletti A, Lettino M, Campana C, et al. Favourable effects of heart rate reduction with intravenous administration of ivabradine in patients with advanced heart failure. Eur J Heart Failure. 2008;10(6):550-5.

Fox K, Ford I, Steg PG, Tendera M, Ferrari R, Investigators B. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet. 2008;372(9641):807-16.

Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 2010;376(9744):875-85.

Borer JS. Clinical Effect of ‘Pure’Heart Rate Slowing with a Prototype I f Current Inhibitor: Placebo-Controlled Experience with Ivabradine. Heart Rate Slowing by If Current Inhibition: Karger Publishers; 2006:54-64.

Berdeaux A. Ivabradine (Procoralan) alone or with b-blockers in myocardial ischemia. Heart Metab. 2010;47:30-3.