Ivabradine did not reduce the risk of myocardial injury after noncardiac surgery (MINS) compared with placebo in patients over the age of 45 years with, or at risk of, atherosclerotic disease, according to findings from the PREVENT-MINS trial presented at ESC Congress 2025.

Conducted at 26 hospitals in Poland, researchers randomized approximately 2,000 patients to receive ivabradine (5 mg orally twice daily for up to 7 days, starting one hour before surgery) or placebo. The median age of participants was 70 years and 49.4% were women. While the trial intended to enroll around 2,500 patients, the independent Data Monitoring Committee recommended early termination for futility based on the prespecified interim analysis. The primary outcome was MINS within 30 days from randomization.

Overall results found that MINS occurred in 17% of patients in the ivabradine group compared with 15% in the placebo group at 30 days. In prespecified subgroup analyses, ivabradine was associated with an increased risk of MINS among patients with a history of coronary artery disease, but not among patients without a history of coronary artery disease, researchers said. In other findings, the intraoperative mean heart rate was lower in the ivabradine group by 3.2 beats per minute than in the placebo group, with no difference in intraoperative mean arterial pressure. Clinically important bradycardia was more common in the ivabradine group compared with the placebo group.

"Ivabradine did not reduce the risk of MINS in patients undergoing noncardiac surgery," said Wojciech Szczeklik, MD, in presenting the findings. "Heart-rate lowering was modest and the possible higher MINS incidence in patients with known coronary artery disease is contrary to our original hypothesis. Further research is needed to establish a method to safely control the heart's stress associated with noncardiac surgery."