Persistent sinus tachycardia after anterior ST-segment elevation myocardial infarction (STEMI) can hinder recovery and increase complications, especially when β-blocker up-titration is restricted by hypotension or left-ventricular dysfunction. A single-center, open-label, randomized controlled trial published in Cardiovascular Drugs and Therapy evaluated the benefits of adding ivabradine (5 mg twice daily) to maximally tolerated bisoprolol versus continued bisoprolol titration alone.

The study included 140 patients with anterior STEMI and a resting heart rate ≥70 bpm after primary percutaneous coronary intervention. Ivabradine lowered heart rate by about 10 bpm at all time points (P < 0.05) and improved LVEF earlier (+5.7% at 6 months, P = 0.015; sustained at 12 months). B-type natriuretic peptide (BNP) declined faster with ivabradine (P = 0.038). Twelve-month MACE-free survival was similar between groups (82.9% vs 80.0%, P = 0.664), and adverse events were infrequent.

These findings suggest that ivabradine safely enhances heart-rate control and promotes early ventricular recovery in anterior STEMI patients when β-blocker therapy cannot be further intensified.