Safety and efficacy of ivabradine in the treatment of patients with acute myocardial infarction: a real-world propensity score matching study

Ivabradine, a selective If channel inhibitor, reduces heart rate without impairing myocardial contractility. Evidence regarding its safety and efficacy in the acute phase of acute myocardial infarction (AMI) remains limited and conflicting.

We analysed data from 136 033 patients with AMI admitted to 82 hospitals in Tianjin, China, between 2010 and 2024. Primary outcomes were in-hospital mortality and 1-year cardiac mortality; secondary outcomes included 1-year all-cause mortality and other adverse events. Propensity score matching (PSM) was used to balance baseline characteristics between patients receiving ivabradine during hospitalization and controls. Logistic regression and Cox proportional hazards models were used to estimate outcome associations. Pre-specified subgroup analyses were conducted. Robustness was assessed using inverse probability of treatment weighting, overlap weighting, E-value analysis, complete-case analysis, treatment-pattern comparator analysis according to background beta-blocker use, and beta-blocker dose-intensity analysis. After PSM, in-hospital ivabradine use was associated with higher in-hospital mortality [aOR, 1.66 (95% CI, 1.19–2.32); P = 0.003], 1-year cardiac mortality [aHR, 1.22 (95% CI, 1.01–1.47); P = 0.043], and 1-year all-cause mortality [aHR, 1.19 (95% CI, 1.01–1.40); P = 0.040] in the fully adjusted model. No significant differences were observed in other secondary outcomes. Subgroup analyses suggested stronger associations among patients aged ≥65 years. Additional analyses showed that the mortality association was most pronounced among patients receiving ivabradine without concomitant beta-blocker. Sensitivity analyses yielded directionally consistent findings.

In this large real-world AMI cohort, in-hospital ivabradine use was associated with higher in-hospital and 1-year mortality, without clear evidence of benefit for other secondary outcomes.