Abstract:
BACKGROUND:Coronary CT angiography (CCTA) is increasing seen as a first line investigation in patients with suspected coronary artery disease. Heart-rate control improves the image quality and diagnostic accuracy of CCTA. Typically, beta-blockers are administered to induce sinus bradycardia. Sinus bradycardia may also be induced by ivabradine. We hypothesized that in a real-world population ivabradine would be an effective alternative to metoprolol at heart rate lowering for CCTA. METHODS:This was a retrospective analysis of consecutive patients who were exposed to an ivabradine-based (IB) versus a metoprolol-only (MO) protocol to achieve a target heart rate = 65bpm. Hemodynamic responses to both strategies were compared along with differences in cost and the time expired from medication administration to CCTA. RESULTS:5955 consecutive patients were included in the analysis: 3211 were imaged during an era of a metoprolol only strategy (MO) and 2744 CCTA following an ivabradine based (IB) strategy. 2676 patients had heart rates >65 and received heart-rate lowering medication: 1958 patients had MO, and 718 received IB protocol. Target heart rate of = 65bpm was achieved in 77% of MO and 89% of IB patients (p < 0.01). The time from initial medication administration to CCTA was longer in the IB versus MO patients (77 versus 48 min, p < 0.01). CONCLUSIONS:Introduction of a novel single dose ivabradine-based protocol to control heart rate for CCTA was more successful in achieving target heart rate than a metoprolol-only strategy. The use of ivabradine however incurred a 1.6-fold increase in the time delay from medication administration and imaging compared to a metoprolol only protocol.
journal_name
J Cardiovasc Comput Tomogrjournal_title
Journal of cardiovascular computed tomographyauthors
Guler EC,Yam Y,Jia K,El Mais H,Hossain A,Chow BJW,Small GRdoi
10.1016/j.jcct.2020.09.006subject
Has Abstractpub_date
2020-10-06 00:00:00eissn
1934-5925issn
1876-861Xpii
S1934-5925(20)30445-7pub_type
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更新日期:2015-09-01 00:00:00
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pub_type: 共识发展会议,杂志文章
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更新日期:2012-07-01 00:00:00
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pub_type: 杂志文章
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