What is the role of increased heart rate in acute coronary syndromes?

Heart rate (HR) plays a major role in the pathophysiology of acute coronary syndromes (ACS). Epidemiological surveys report a direct relationship between HR and outcomes after myocardial infarction, and increased HR has been identified as an independent risk factor for ACS. Reducing HR is expected to be a valuable therapeutic strategy in ACS. The disadvantages of HR reduction with -blockers in ACS include contraindications and tolerance issues, as well as mixed trial results, particularly in moderate- to high-risk patients; the beneficial effects of calcium channel blockers are also inconsistent. HR reduction with the selective If inhibitor ivabradine may have potential in this setting. This is currently being tested in VIVIFY (eValuation of the IntraVenous If inhibitor ivabradine after ST-segment elevation mYocardial infarction)