Ivabradine in acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials

Introduction: While effective in stable angina and chronic heart failure, ivabradine’s role in acute myocardial infarction (AMI) is less clear. We assessed the effects of ivabradine versus placebo or standard care on all-cause mortality, major adverse cardiovascular events (MACE) and heart failure in AMI patients. 

Methods: We systematically searched six databases through April 2025 for randomized controlled trials (RCTs) comparing ivabradine to control therapy in AMI. Primary outcomes included all-cause mortality, MACE, and heart failure incidence. Random-effects meta-analysis was conducted, with sensitivity analyses using the IVhet model. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and publication bias was explored via funnel plots. 

Results: Fifteen RCTs involving 2220 patients (ivabradine: 1126; control: 1094) were included. Ivabradine did not significantly reduce all-cause mortality (OR 0.66, 95% CI: 0.38–1.16), though the trend favored treatment. It significantly reduced MACE (OR 0.49, 95% CI: 0.30–0.82; I² = 12%) and heart failure events (OR 0.60, 95% CI: 0.40–0.90). Subgroup analysis indicated greater benefit when combined with beta-blockers. Sensitivity analyses confirmed these findings. 

Conclusion: Ivabradine may reduce cardiovascular complications post-AMI, particularly MACE and heart failure, and may serve as a useful adjunct to standard therapy. Further large-scale trials are warranted. 

Registration: This systematic review and meta-analysis was registered on PROSPERO (CRD420251054716).