Clinical Trial Finds Ivabradine Ineffective in Reducing Myocardial Injury Post-Noncardiac Surgery

A recent late-breaking study presented at ESC Congress 2025 has shown that ivabradine, a heart rate-lowering medication commonly used in angina and heart failure, does not decrease the risk of myocardial injury after noncardiac surgery (MINS). MINS is a significant postoperative complication, responsible for approximately 13% of deaths within 30 days following surgery.

The double-blind, placebo-controlled PREVENT-MINS trial was conducted across 26 hospitals in Poland, involving 2,101 patients aged 45 and older with established or high risk for atherosclerotic disease. Participants received either ivabradine at 5 mg twice daily, starting one hour before surgery, or a placebo. The primary measure was the incidence of MINS within 30 days post-surgery.

Results showed that MINS occurred in 17% of the ivabradine group compared to 15.1% in the placebo group, with no statistically significant difference (RR 1.12; p=0.25). Interestingly, patients with a history of coronary artery disease experienced a higher risk of MINS when on ivabradine (RR 1.49), suggesting a potential adverse effect in this subgroup. Although ivabradine modestly lowered intraoperative heart rate by about 3.2 beats per minute, it did not translate into a reduced risk of myocardial injury.

Additional findings indicated that clinically significant bradycardia was more common among patients taking ivabradine, and overall, the medication did not provide the anticipated cardioprotective benefit. Professor Wojciech Szczeklik, the study's principal investigator, concluded that heart rate reduction achieved with ivabradine was insufficient and may not be beneficial in this context. Further research is necessary to identify safe and effective strategies for preventing cardiac complications during noncardiac surgery.

This study adds to the growing body of evidence questioning the role of heart rate lowering as a protective strategy in perioperative care. For now, the results suggest that ivabradine should not be used for myocardial injury prevention in this setting.