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European Heart Journal Advance Access originally published online on August 31, 2009
European Heart Journal
2009 30(19):2337-2345; doi:10.1093/eurheartj/ehp358
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Relationship between ivabradine treatment and cardiovascular outcomes in patients with stable coronary artery disease and left ventricular systolic dysfunction with limiting angina: a subgroup analysis of the randomized, controlled BEAUTIFUL trial

Kim Fox1,*, Ian Ford2, Ph. Gabriel Steg3, Michal Tendera4, Michele Robertson2, Roberto Ferrari5 on behalf of the BEAUTIFUL Investigators

1 Royal Brompton Hospital, Sydney Street, London, UK
2 Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
3 INSERM U-698, Hôpital Bichat-Claude Bernard, AP-HP, University Paris 7, Paris, France
4 Medical University of Silesia, Katowice, Poland
5 Chair of Cardiology, University of Ferrara, S. Maugeri Foundation, Ferrara, Italy

Received 18 June 2009; revised 11 August 2009; accepted 12 August 2009; online publish-ahead-of-print 31 August 2009.

* Corresponding author. Tel: +44 207 352 8121, Fax: +44 207 351 8629, Email: k.fox{at}rbht.nhs.uk

See page 2300 for the commentary on this article (doi:10.1093/eurheartj/ehp360)

Aims: BEAUTIFUL found no impact of ivabradine on outcomes in patients with stable coronary artery disease (CAD) and left ventricular systolic dysfunction (LVSD). We performed a post hoc analysis of the effect of ivabradine in BEAUTIFUL patients whose limiting symptom at baseline was angina, particularly in terms of coronary outcomes.

Methods and results: Of the BEAUTIFUL population, 13.8% had limiting angina at baseline (734 ivabradine, 773 placebo); of these, 712 patients had heart rate ≥70 b.p.m. Median duration of follow-up was 18 months. Ivabradine was associated with a 24% reduction in the primary endpoint (cardiovascular mortality or hospitalization for fatal and non-fatal myocardial infarction [MI] or heart failure) (HR, 0.76; 95% CI, 0.58–1.00) and a 42% reduction in hospitalization for MI (HR, 0.58, 95% CI, 0.37–0.92). In patients with heart rate ≥70 b.p.m., there was a 73% reduction in hospitalization for MI (HR, 0.27, 95% CI, 0.11–0.66) and a 59% reduction in coronary revascularization (HR, 0.41, 95% CI, 0.17–0.99). Ivabradine was safe and well tolerated.

Conclusion: Our analyses raises the possibility that ivabradine may be helpful to reduce major cardiovascular events in patients with stable CAD and LVSD who present with limiting angina. However, a large-scale clinical trial is ongoing, which will formally test this hypothesis.

Key Words: Coronary artery disease • Heart rate • If inhibition • Ivabradine • Prognosis • Stable angina pectoris


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Related articles in EHJ:

A BEAUTIFUL lesson—ivabradine protects from ischaemia, but not from heart failure: through heart rate reduction or more?
Gerd Heusch
EHJ 2009 30: 2300-2301. [Extract] [FREE Full Text]  



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G. Heusch
A BEAUTIFUL lesson--ivabradine protects from ischaemia, but not from heart failure: through heart rate reduction or more?
Eur. Heart J., October 1, 2009; 30(19): 2300 - 2301.
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