TAP CHl NGHI§N CLPU Y HQC
VAI TRO C O A IVABRADINE TRONG PH6I HOP DI^U TR! BENH NHAN NH6I MAU C Q TIM C A P
DA CAN THIEP DONG MACH VANH QUA DA
Nguydn M?nh Qudn, Nguydn Quang Tuin, Pham Thj Tuylt Nj Vidn Tim mpch Vidt Nam - Bdnh vidn Bpch /K Vai tn!) ciia Ivabradine dd dugc chimg minh trdn ddi twang bdnh ddng mpch vdnh (DMV) dn djnh, fi nhidn ehwa cd nghidn cdu ndo trdn bdnh nhdn nhdi mdu ca tim (NMCT) cip dd can thidp DMV qua da. M(
tidu cua di tdi nhim nghidn cdu hidu qud vd nhOng tdc dung khdng mong mudn cua ivabradine trong ph hgp diiu tri bdnh nhdn NMCT cip dd can thidp DMV qua da. Kit qud eho thay phdi hap Ivabradine Idm gik tin sd tim sau 1 tuin. cdi thidn tinh trpng dau ngwc, muc dd khd thd sau 1 thdng (p < 0.01). idm giim ngi ea biin cd tim mach chlnh. tdi nhdp vidn do suy tim sau 12 tuin so vdi nhdm diu tn theo quy chu^
Ivabradine dung npp tdt vd an todn. Kit ludn: phdi hap Ivabradine Idm cdi thipn chit lugng cudc sdng vd &
lugng a bdnh nhdn NMCT dp dd can thidp DMV qua da.
TIP kh6a: Ivabradine, nhdi mdu co- tim, can thiOp d^ng m^ich vdnh qua da
I. DAT
V A N D £NMCT c l p Id mdt cap c&u nOi khoa vdi nhieu bien ch&ng nguy hiem. Mge du dd ed nh&ng tidn bp trong chan doan vd dieu trj, nhung bOnh vdn cd tiOn lu-ang ndng, ty 10 t&
vong cao [2, 4, 10]. Nhidu nghiOn c&u eho thay viOc giam tan sd tim khdng chi nhdm dieu tri NMCT cap md cdn ngdn ng&a bien ch&ng, cai thiOn tiOn luang, mang lai lai Ich Idu ddi eho bOnh nhdn [9, 10], Thude chen beta giao cam lam giam t i n sd tim du-ac chi djnh trong vdng 24 gid d i u eho tat c l cdc bOnh nhdn NMCT clp. Tuy nhiOn, nhidu bOnh nhdn ed chdng chi djnh s& dgng thudc chen beta giao cam nhu suy tim, giam cung lu-Q-ng tim, block nhT thit dO 2 3, hen phd quan,... Ivabradine la thude Idm giam nhjp tlm mOt cdch chuyOn biOt, dd dup-c nhieu nghiOn c&u ldn trOn thd gidi eh&ng minh tdc dung [8], tuy nhiOn chu-a cd nghiOn c&u ndo trOn ddi tu-ang NMCT d p dd can thiOp DMV qua da. Do dd dk tdi du-ac thyc hiOn nhdm muc tlOu:
NghlOn c&u hiOu qua cua Ivabradine trong phdi hgp dieu trj bOnh nhdn NMCT c l p dd can
thiOp OMV qua da (so sdnh vdi nhdm dieu I quy chuln).
Ddnh gid nh&ng tdc dung khdng mor mudn eua Ivabradine trong phdi hap dilu I cho cde bOhh nhdn trOn.
II. D 6 | TU'gNG VA PHU'aNG PHAP
1. Ddi tuning
Bao gdm 158 bOnh nhdn du-ac ehln doa xdc djnh NMCT c l p theo tiOu chuln cua ES(
ACC 2007 (Hdi Tim mgch chdu Au vd Tntdn mdn Tim mgch Hoa Ky) [4], dd du'ae can thl?
DMV qua da, vd cd diOn tdm dd sau can thi^
Id nhjp xoang, vdi t i n sd tim s 70 lan/phil ndm 'dieu tri ndi tru tgi ViOn Tim mgch Qu^
gia ViOt Nam t& thdng 10/2010 den thdr 3/2011. Cdc bOnh nhdn du'O'c chia ldm 2 nhbn
+ Nhdm phdi hp-p: dieu trj theo khuyen ca cua HOi tim mgch hQC ViOt Nam 2008 [3], d^r thdi du'O'c dung Ivabradine theo quy trinh.
+ Nhdm quy chuln: dieu trj theo khuy^
cdo eua HOi tim mgch hoe ViOt Nam 2008.
TiOu chuln logi tr&: cd cde rdi loan nh tim (rung nhT, rdi logn nhjp thit, block.|i
"^TAP CHl NGHIEN CO'U Y HQC
hit,...), du-ac dat may tao nhjp tlm, dang ed )enh ly noi khoa khac Idm tdng nhjp tlm (thieu ndu, nhiOm trung, basedow,...), suy gan, suy ban nang,..,
2. Phu'ang phdp
Phu-ang phdp: nghien c&u thu nghiOm am sang cd so sanh vdi nhdm eh&ng.
Quy trinh dung Ivabradine: Ivabradine 5mg X 2 lan/ngay trong 1 tuin. Sau 1 tuin neu ihjp tlm luc nghi > 70 lan/phut thi du-p-c tdng leu ivabradine lOn 7,5mg x 2 lln/ngdy, tu 50- 39 lan/phut thi gi& nguyOn lieu 5mg x 2 lln/
igay, neu nhjp tlm < 50 lln/phiit hodc cd triOu Dh&ng do chdm nhjp tim thl ng&ng s& dung vabradine.
Cdc budc tidn hanh vd ede thOng sd ighiOn c&u:
+ BOnh nhdn du-ac kham, lam xet nghiem Jdy du (sinh hoa mau, diOn tam dd, siOu am im), cac thong tin du'ae ghi nhan theo mdu )Onh an nghiOn c&u.
+ Cac bOnh nhan ddu du-ac dieu tri noi choa tdi u-u theo dung khuyen eao eCia Hoi tim nach hoe ViOt Nam 2008, du-ac chup vd can hiOp DMV qua da, chia nglu nhiOn thdnh hai ihdm: Nhdm phdi hap va nhdm dieu tri theo luy chuan.
+ Trong 7 ngdy d i u tiOn cua nghiOn cuu )Onh nhan du-ac theo ddi, danh gia t i n sd tim je nghi mdi ngay, dieu chinh lieu thudc theo lung quy trinh.
+ Sau 1 thang bOnh nhan du-gc hen tdi
;ham, kiem tra cae triOu ch&ng lam sang, can am sang. Trong thdi gian nghiOn c&u bOnh
han duge theo ddi eac tac dung phu cd the dp do dung thude (trieu eh&ng nhjp chdm, )a mit,...).
+ Thdng kO trong thdi gian 12 tuin ke t&
ic b i t d i u nghiOn c&u: cae bien ed tim maeh ao gdm t& vong do tim mgch, tai nhdp viOn
do NMCT d p hay D T N K O O , tdi nhdp vIOn do suy tim, cdc bien cd khde.
Cdc sd HOu cua nghiOn cuu dugc phdn tich bing phin mem SPSS 16.0, su dung cdc thudt todn thdng kO y hpc.
III. K^T QUA
1. Ddc didm chung cua cdc benh nhan nghien cu'u
+ Tudi trung binh cua bOnh nhdn trong nghiOn c&u Id 63,85 ± 9,98 tudi. Nam gidi chiem 72,8%, g i n g i p 3 lan n& gidi (27,2%).
Tudi trung binh vd ty 10 phdn bd nam nu d hai nhdm nghiOn c&u Id tu-ang duang nhau (P > 0,05).
+ KhOng ed sy khae biOt gi&a hai nhdm nghiOn cuu ve tien su bOnh vd ede yeu td nguy ca bOnh tim maeh (p > 0,05), cung nhu tri sd trung binh HA tam thu, HA tam truang, tan sd tim luc nghi va muc do NYHA. Ket qua tu-ang ty khi so sanh mOt sd chi sd can lam sang giua hai nhom (dien tam dd, siOu dm tim, sinh hoa mau)
+ Ket qua chup DMV cho thay ty 10 DMV thu pham d hai nhom nghien cuu tu'ang du'ong nhau, trong do chu ydu la nhanh LAD, tidp den la nhdnh RCA va cudi cung Id nhdnh Lex (3,8% d ea hai nhom). Kdt qua can thiOp DMV deu tdt, ddng chay trong DMV dgt m&c dp TlMl 3 la tuang duang nhau d hai nhdm nghiOn cuu (p > 0,05).
.2. Kdt qua thay ddi tdn sd tim trong 7 ngdy ddu nghien CLPU
Bieu dd 1 cho thay tan sd tim cua ea hai nhdm deu giam di trong tuin d i u tiOn. Nhdm quy chuan giam trung binh 10,72 ± 7,54ek/
phut. Nhdm phdi hgp giam trung binh 18,08 ± 9,13ck/phut. Vd m&c dp giam tan sd tim d nhdm phdi hap ldn han nhdm quy chuan 7,35
± 1,33ek/phutvdl p < 0,001.
TCNCYH 78 (1) - 2012 59
TAP CHl NGHIEN CU'U Y HQC 100
95 90 85 ^ 80 75 70
•Nhdm quy chuln
•Nhdm phdi hpp
Ngdy Ngdy Ngdy Ngdy Ngdy Ngdy Ngdy Ngdy
0 1 2 3 4 5 6 7
Bidu dd 1. Bidn ddi t i n sd tim trong 7 ngdy ddu nghien ciru ' Lidn quan giwa giim tin s6 tim vi tidn Iwgng d bdnh nhin NMCT cip
Sau 1 tuin didu tri, nhdm phdi hap cd 69,6% bOnh nhdn dgt t i n sd tim < 80 ck/phiit, cao h so vdi nhdm quy chuln (48,1 %) (OR = 2,47; 95%C1 1,29 - 4,74, p = 0,01).
10- 1 T i n sd tim < 80 ck/phut
p = 0,012 Logrank - .5;
w o>- O o
3 T i n sd tim > 80 ek/phut
HR = 7,56 (1,66-34.52) P = 0,009
Thdi gian theo ddi (tuin) Bidu dd 2. Mdi lien quan giipa t i n sd tim vd ty 10 sdng cdn
Sau 12 tuin theo ddi, bidu dd 2 cho thiy sy khde biOt gi&a hai nhdm cd y nghTa thdng kO vdi p-Logrank = 0,012. Nguy ca t& vong eua nhdm cd t i n sd tim s 80^ ek/phut eao han g i p 7,56 lln so vdi nhdm cd t i n sd tim < 80ck/phut (HR = 7,56; 95% Cl 1,66 - 34,52, p = 0,009).
3. Kdt qua lam sdng, cdn Idm sdag sau 1 thdng theo ddi
M&c dO dau ngye, NYHA vd t i n sd tim luc nghi d nhdm phdi hgp sau 1 thang deu giam
so vdi ban d i u vd r i t ed y nghTa thdng kd v p < 0,001. Vd cdc chl sd ndy d nhdm phdi h«
khi so sdnh vdi nhdm dieu trj quy chuan s£
1 thdng thiy v l n t h l p han ed y nghTa thor kO vdi p < 0,01. HATT vd HATTr khOng c6 nghTa thdng kO gi&a 3 nhdm so sSr (P > 0,05).
Cde chf sd xOt nghiOm mdu, siOu dm tii sau 1 thdng d hai nhdm khdng ed sy khde bii ed y nghTa thdng kO vdi p > 0,05.
TAP CHl NGHIEN CCPU Y HQC
4. Kdt qua cdc biln cd tim mach chinh qua theo doi doc
Qua thdi gian 12 tuin trOn 158 bOnh nhdn eua nghiOn c&u, kdt qua theo ddi cdc bidn ed tim mach chlnh du'gc trinh bdy d bang 1 du-di ddy.
Bang 1. Kdt qua cdc bidn cd tim mgch chinh sau 12 tuin
Bidn cd chinh
T& vong
Tdi nhap viOn do N M C T / D N K O D
Tdi nhdp viOn do Suy tlm
T B M N
Tdng cdng
Nhdm phdi hp'p (n = 79) 5 (6,3%) 4(5,1%) 5 (6,3%) 1(1,3%) 15(19%)
Nhdm quy chuln (n = 79) 7 (8,9%) 6 (7,6%) 14(17,7%)
2 (2,5%) 29 (36,7%)
P
>0,05 0,028
>0,05 0,021 De tim hieu rd han sy khde biOt nguy ca tdi nhdp viOn do suy tim vd nguy ca mie bidn cd tim mach chinh gi&a hai nhdm phdi hap vd nhdm dieu trj theo quy chuln theo thdi gian, ehung tOi su dung du-dng cong Kaplan-Meier de bleu diOn sy khde biOt vd mO hlnh hdi quy Cox de tinh ty sd nguy ea Hazard Ratio (HR).
HR = 2,09 (1,12-3,91) p = 0.02
CT
O
0.0-
Nhdm quy chuan o
CT CD>- Z3
a
Nhdm phdi hap Thdi gian theo dOi
HR =
/ / / / / /
\ 1 : 4
= 2,09(1,12-3,91) p = 0,02
Nhdm quy chuln
y
-—•—•— Nhdm phdi hap Thdi gian theo ddi
5 8 10 12 •
Bieu dd 3. Ty le bidn cd tim mach chinh cua hai nhdm nghien CIPU
Bleu dd 3 eho thiy sau 12 tuan theo ddi, nhdm quy chuan ed nguy ea gdp nhieu bidn ed tim mgch chinh han g i p 2,09 l l n so vdi nh'dm phdi hap Ivabradine (HR = 2,09; 95%C1 1,12 3,91, p = 0,02). Nguy ea tdi nhdp viOn do suy tim eua nhdm quy chuln eao han g i p 2,96 lan so vdi nhdm phdi hgp (HR = 2,96;
95% Cl 1,07-8,23, p = 0,037).
Bidu dd 4. Ty 10 tdi nhap vien do suy tim cua hai nhdm nghien cii'u
5. Tdc dung khdng mong mudn ciia Ivabradine
Trong qud trinh nghiOn c&u, nhdm phdi hgp ed 9 trudng hgp (11,4%) Ida mit, trong khi do nhdm quy chuln khdng gdp tru-dng hgp ndo. Tuy nhiOn ed 8 tru-dng hgp triOu eh&ng thodng qua.
Ngodi ra ea hai nhdm deu cd nh&ng bOnh
TCNCYH 78 (1) 2012 61
TT/^P CHl NGHliN CU'U Y H Q ^
nhdn gdp triOu ehung chdm nhjp tim ho$e rdi logn nhjp tim (rung nhT vd ngogi tdm thu thit), tuy nhiOn sy khde biOt khdng ed y nghTg thdng kO vdi p > 0,05.
IV. BAN LUAN
t
Kdt qud thay ddi t i n sd tim trong tuin ddu nghien ciPU
Sau 7 ngdy didu tri, nhdm quy chuln gilm trung binh 10,72 ± 7,54 ehu ky/phCit. Nhdm phdi hgp giam 18,08 ±9,13 ehu ky/phut, m&c dO gilm ldn han nhdm quy chuln 7,35 ± 1,33 chu ky/phut vdi p < 0,001. BOn cgnh dd, ed ddn 69,6% sd bOnh nhdn nhdm phdi hgp Ivabradine dgt duge t i n sd tim < 80 ehu ky/
phut sau 1 tuin, eao g i p 2,47 lln nhdm quy chuln, chi ed 48,1%, sy khde biOt cd y nghTa thdng kO vdi p = 0,01, OR = 2,47; 95% Cl (1,29 - 4,74). TrOn the gidi dd ed nhieu nghiOn c&u vd mdi liOn quan gi&a viOc giam nhjp tim vd NMCT. ViOc giam t i n sd tim se lam dn djnh mang xa'v&a, giam m&c tiOu thu oxy ea tim vd kOo ddi thdi gian tdm tru-ang, Idm tdng tudi mdu cho ddng mach vdnh. Phdn tieh gdp cua Cueherat vd cdng sy cho thiy nhjp tim giam di 10 nhjp/phut se ldm giam 26% ty 10 t& vong do tim [6]. Kdt qua thu du'ae d bidu dd 2 eho thiy rd nguy ea t& vong do tim mgch d nhdm cd t i n sd tim > 80 ehu ky/phut cao han g i p 7,56 lln nhdm cd t i n sd tim < 80 ehu ky/phut (HR = 7,56;95% Cl, 1,66 - 34,52, p = 0,009).
Cd thd ndi khi phdi hap Ivabradine Idm tdng k h i ndng dgt du-gc m&c t i n sd tlm < 80 chu ky/phut sau 1 tuin. Id mdt ydu td dOe ldp tlOn lu'gng nguy eg t& vong cua bOnh nhdn sau 12 tuin theo ddi.
Thay ddi Idm sdng, c$n Idm sdng sau 1 thdng theo ddi
So vdi ban d i u vd so vdi nhdm quy chuln, ede bOnh nhdn d nhdm phdi hgp Ivabradine dd ea' thiOn r i t nhieu trOn Idm sdng. T i n ad
tim ICic nghf gilm, m&c dO dau ngye (thai phdn dO CCS) du-gc e l i thiOn rd rOt, cQng nhi m&c dO khd thd (theo phdn dO NYHA) vd 6k cd y nghTa thdng kO vdi p < 0,01, Chit lu-gnj cuOc sdng eua bOnh nhdn du-gc eli thiOn ri rOt khi dung phdi hgp Ivabradine. Chi sd trung binh HA tdm thu vd tdm tru-ang khdng c6 sy khde blOt ed y nghTa thdng kO sau 1 thdngso vdi ban d i u vd so vdi nhdm quy chuln (p >
0,05). Nhu- vdy khi phdi hgp Ivabradine giijp gilm t i n sd tim, cdi thiOn ede triOu eh&ng ldm sdng, vd khdng gdy I n h hu-dng ddn huydt dp.
T& kdt q u i nghiOn c&u eho thiy phdi hgp Ivabradine khdng gdy I n h hu-dng b i t lgi 6kn ede chl sd xOt nghiOm mdu cOng nhu- khOng ldm gilm phdn sd tdng mdu thit trdi.
Bidn cd tim m^ch chinh qua theo doi dpc 12 tuin
Bang 1 eho thiy ty 10 tdi nhdp viOn do suy tim khOng t& vong d nhdm quy chuln Id 17,7%, eao han nhdm phdi hap (6.3%) vdi p = 0,028. Td hgp bien ed tim maeh chinh d nhdm quy chuln Id 36,7%. eao han nhdm phdi hgp (19%) vdi p = 0,021
So sdnh vdi nghiOn c&u cua Nguyin Quang T u i n [2] ed ty 10 bidn d tim mgch ehlnh (t& vong, tdi NMCT, TBMN) trOn bdnh nhdn du-ac didu tri quy chuln trong 30 ngdy d i u Id 11%, sau 1 ndm Id 20%, nghiOn ciru cua Chung tdi trOn bOnh nhdn phdi hcrp Ivabradine cd ty 10 trong 30 ngdy d i u Id 8,9%
vd sau 12 t u i n Id 12.7%. Cl nghiOn cii-u ' BEAUTIFUL, Ivabradine khdng cai thiOn du-gc ty 10 tdi nhdp viOn do suy tim d nhdm bdnh nhdn bOnh mgch vdnh dn djnh vdi'HR=0,97;
95%CI (0,82 - 1,15); p = 0,76 [8].
Tdc dgng khdng mong mudn khi ph6i hp'p Ivabradine
Lod m i t Id tdc dung phy hay gdp nhit cua Ivabradine. Dieu ndy liOn quan den tdc dung trOn kOnh f cua" thude. KOnh f Id mOt trong cdc
TAP CHI NGHliN CCPU Y HQC
kOnh HON (hyperpolarization-aetlvated, cyclic nueleotide-gated cation channels). KOnh HCN
1 vd 2 phdn bd d v6ng mge mdt, edn kOnh HCN 4 phan.bd trong tim. Tuy nhiOn tinh chgn lpc eua thudc trOn HCN 4 so vdi trOn cde kOnh HCN khac da cd bdng ch&ng Idm sdng rO rang. Cae nghien c&u dd ch&ng minh ivabradine khdng anh hu-dng den cdc thOng sd dien sinh ly hoc, d i n truyen nhT that cung nhu dan truyen trong that [7]. Trong nghlOn c&u eua Chung tdi khdng gdp nhjp chdm khong triOu ch&ng hay dj &ng thudc. Ket qua tuang ty nhu nghiOn c&u BEAUTIFUL, SHIFT [8]. Ngoai ra Babu SK [5] ch&ng minh ring Ivabradine an toan khi dimg cho benh nhdn hen phe quan, cung khdng anh hudng den kiem soat du'dng huyet d bOnh nhan dai thdo du-dng, cung nhu' khdng gay hiOu &ng biing phat khi d&ng thude dot ngot, do dd khi d&ng thudc khOng can giam lidu t& t&. Oieu nay eho thiy Ivabradine la mot thudc dung ngp tdt va cd dp an toan eao khi s& dung trOn lam sang.
V. K^T LUAN
Lam giam t i n sd tim nhieu han nhdm quy chuan sau 1 tuin va sau 1 thang (p < 0,01).
Sau 1 tuin dieu tri, phdi hap Ivabradine lam tang kha nang dat m&c t i n sd tim < 80 ck/
phut g i p 2.47 lan nhdm quy chuan. d i n den giam nguy ca t& vong do tim maeh 7.56 lan sau 12 tuin theo doi.
- Cai thiOn tinh trang dau ngye (theo phdn dO CCS), m&c dp khd thd (theo NYHA) sau 1 thang so vdi nhdm quy chuan (p < 0,01).
Nhdm didu tri quy chuln ed nguy ca bien ed tim mgch ehlnh cao han g i p 2.09 lln, liguy ca tai nhgp vien do suy tim gap 2,96 lan nhdm phdi hgp Ivabradine (p < 0,05).
Ivabradine dung nap tdt va an todn eao khi su dung tren lam sang.
TAI
LIEU THAM
K H A O1. Le Xudn Thdn (2009). NghlOn c&u vai trd tiOn lu'gng sdm cua thOng sd E/Em trOn slOu dm Doppler tim d bOnh nhdn nhdi mdu ca tim d p . Ludn vdn tdt nghiOp Bdc s9 nOi trii, Dgi hoc Y Hd NOI.
2. NguyOn Quang Tudn (2005). NghiOn c&u hiOu qua eua phu-ang phdp can thIOp dOng mgch vdnh qua da trong dieu tri nhdi mdu ea tim d p . Ludn vdn tien sy y hpc, Dal hoc Y Hd NOi.
3. NguyOn Lan Vipt, Nguydn Quang Tudn, Nguyin Thj Bach Yin (2008). Khuydn cdo 2008 cua HOI tlm mgch hoc ViOt nam ve x& tri nhdi mdu ea tim d p cd dogn ST chenh lOn. Khuyen cdo 2008 ve'ede bOnh ly tim mach vd chuyen hda, Nhd xuat ban y hpc, 394-435.
4. Anthony A.Hilliard (2008). Myocardial Infarction. MayoCllnic Cardiology concise textbook, 3: 685-883.
5. Babu SK, Holgate ST, Gadzik F (2008).
Absence of respiratory effects in asthmatic subjects with the If inhibitor ivabradine, a novel antianginal agent. Br J Clin Pharmacol. Jul; 66 (1): 96-101.
6. Cueherat M (2007). Quantitative relationship between resting heart rate reduction and magnitude of clinical benefits in post-myocardial infarction: a meta-regression of randomized clinical trials. Eur Heart J; 28:
3012-3019.
7. DiFrancesco D, Camm JA (2004).
Heart rate lowering by specific and selective I (f) current inhibition with ivabradine: a new therapeutic perspective in cardiovascular disease. Drugs; 64: 1757-1765.
8. Fox K, Ford I, Steg PG, Tendera M, Ferrari R, et al (2008). Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind,
TCNCYH 78 (1) - 2012 63
TAP CHl NGHliN CLPU Y HQC
placebo-controlled trial, Laneet,;372: 807-816, 10. Thomas JT, William BK, Halit S et a 9. Hjalmarson A, et al (2006). Heart rate: (2001). Cardiovascular diseases in the Unitei an independent risk factor in cardiovascular States and Prevention Approaches. Thi disease. Eur Heart J; 27(Abstract Suppl): 590, Heart, (1), 3-19.
Summary
ROLE OF IVABRADINE IN COLLABORATION WITH STANDARD TREATMENT FOR POST PRIMARY PERCUTANEOUS CORONARY
INTERVENTION (PPCI) PATIENTS WITH ACUTE MYOCARDIAL INFARCTION (Ml)
Role of Ivabradine in-patients with stable coronary artery disease has been well established, however it has not been proved in AMI patients after PPCI yet. This study was designed to evaluate efficacy and adverse drug reactions of Ivabradine in collaboration with standard treatment of post PPCI patients with AMI. The results showed that Ivabradine as an add-on therapy to post PPCI patients with AMI standard treatment decreased heart rate, improved symptoms such as angina & dyspnea after 1 month of treatment (p < 0,01), reduced major cardiovascular events, rehospitalisation for heart failure after 12 weeks of treatment compared to control group. Ivabradine was proved to be well-tolerated and safe in clinical treatment In conclusion, Ivabraidine in collaboration with standard treatment improves the quality of life and the prognosis in AMI patients after PPCI.
Key words: Ivabradine, myocardial infarction, primary percutaneous coronary intervention
s y 6 N DjNH TH! LU'C VA KHUC XA
SAU
P H A U T H U A TLASIK VA MOT S 6 Y^U
T 6LIEN QUAN
Phgm Thj Hdng L § \ Nguyin Di>c Anh^
^Bdnh vidn Mit Hd Ndi. 'Trwdng Dpi hpc YHa m Hipu qua cua phiu thudt LASIK cd thi bj dnh hwdng bdi nhiiu yiu td trwdc va tmng phiu thupt Nghien cuv dugc thwc hipn nhim ddnh gid (1) sw thay ddi thj luc vd khuc xp cua bdnh nhdn sau phiu thupt LASIK va (2) xdc dnh mdt sd yiu td lidn quan din sw thay ddi thj iwc vd khpc xp sau phiu thudt Nghidn cdu g6/n 124 mit ciia 60 bdnh nhdn. Ty Id mdt cd thj Iwc > 7/10 thay ddi td BC 5% (1 tuin) din 86,3% (6 thdng). Si mdt dpt khuc xp tmng khodng ±0.5D thay ddi tw 76.6% (1 tuin) din'^8SJ5% (6 thdng). Dd in dinh eiia thjli/c vd khuc xa lien quan cd y nghia vdi cdc yiu t6: khuc xp tmdc md, dd ddy gidc mpc, dd ddy md gidc WC duge liy d, thdi gian ddt laser Tw dd cd thi kit ludn, khuc xp trwdc mi, dd day gidc mpc, thdi gian St laser vd dd ddy gidc mpc liy d Id nhwng yiu td chlnh cin chd y tmng phiu thudt LASIK di tang dd 6n (^nh kei qua sau md.
Tip khoa: phiu thudt LASIK, laser in situ keratomileusis
