Hot Line 5: PREVENT-MINS
31 Aug 2025
Hot Line ESC Congress 2025 Ivabradine did not reduce myocardial injury after noncardiac surgery
Professor Wojciech Szczeklik (Jagiellonian University Medical College - Krakow, Poland) said: “It has been proposed that increased heart rate at the time of surgery leads to higher myocardial oxygen consumption, a supply-demand mismatch and myocardial injury. Giving beta-blockers lowers heart rate and decreases the risk of MI, but these benefits may be offset by increased risk of hypotension, death and stroke.1 Ivabradine more selectively slows heart rate than beta-blockers and we conducted the PREVENT-MINS trial to assess whether ivabradine could prevent myocardial injury after noncardiac surgery (MINS) in patients with, or at risk of, atherosclerotic cardiovascular disease (CVD).”
This double-blind Polish trial included 2,101 patients aged ≥45 years with established CVD or substantial risk factors. Patients were randomised to receive ivabradine (5 mg orally twice daily for up to 7 days, starting 1 hour before surgery) or placebo. The primary outcome was MINS within 30 days from randomisation. The trial had intended to enrol around 2,500 patients; however, the independent Data Monitoring Committee recommended early termination for futility, based on the prespecified interim analysis.
MINS occurred in 17.0% of patients with ivabradine and 15.1% with placebo at 30 days (relative risk [RR] 1.12; 95% CI 0.92 to 1.37; p=0.25).
In prespecified subgroup analyses, ivabradine was associated with an increased risk of MINS among patients with a history of coronary artery disease (RR 1.49; 95% CI 1.03 to 2.16) but not among patients without (RR 0.98; 95% CI 0.78 to 1.24). The intraoperative mean heart rate was lower in the ivabradine group by 3.2 bpm than in the placebo group, with no difference in intraoperative mean arterial pressure.
Prof. Szczeklik concluded: “Ivabradine did not reduce the risk of MINS 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.”
References
- Wijeysundera DN, et al. J Am Coll Cardiol. 2014;64:2406–2425.
