Ivabradine is an I(f) current inhibitor, that has documented antianginal 
efficacy. The BEAUTIFUL trial tested ivabradine against placebo in a large 
population of 10,917 patients in sinus rhythm, with coronary artery disease and 
left ventricular dysfunction, defined as left ventricular ejection fraction < or 
=35%. Overall, there was no impact of ivabradine on the primary end-point of the 
trial (cardiovascular mortality, hospitalisation for myocardial infarction, new 
onset or worsening heart failure). In the placebo arm of the trial, baseline 
heart rate > or = 70 bpm was associated with an increased risk of cardiovascular 
mortality, myocardial infarction, heart failure and coronary revascularisation. 
In the subgroup of patients with a baseline heart rate > or =70 bpm, treatment 
with ivabradine resulted in a significant, 36% reduction in the risk of 
myocardial infarction and a 20% reduction in the need for coronary 
revascularisation. Ivabradine was well tolerated, with an increased rate of 
treatment discontinuation, mainly due to bradycardia, compared with placebo. 
Because of its safety and efficacy to control angina, ivabradine should be 
considered first-line antianginal treatment in coronary artery disease patients 
with left ventricular dysfunction and increased heart rate, already receiving 
beta-blocker therapy or in whom these medications are not tolerated.