PREVENT-MINS: Ivabradine does not reduce MINS in non-cardiac surgery

Ivabradine was not associated with a decreased risk of myocardial injury after non-cardiac surgery (MINS). These findings highlight the need for alternative approaches to control perioperative sympathetic stress.

The PREVENT-MINS trial (NCT05279651) investigated whether the administration of ivabradine, which selectively blocks the cardiac pacemaker current (I(f)) in the sinoatrial node, reduces the risk of MINS in adults undergoing non-cardiac surgery.

Prof. Wojciech Szczeklik (Jagiellonian University, Poland) and colleagues randomised 2,101 participants aged ≥45 years undergoing non-cardiac surgery with atherosclerotic disease or at risk for this disease, 1:1 to ivabradine or placebo [1]. In the intervention arm, participants received 5 mg ivabradine orally, twice daily, until day 7 after surgery. The first dose was administered at least one hour preoperatively.

There was no effect of ivabradine on MINS at 30 days of follow-up, the primary endpoint of the trial. In the ivabradine arm, 17.0% experienced MINS compared with 15.1% in the placebo arm (RR 1.12; 95% CI 0.92-1.37; P=0.25). Furthermore, clinically significant bradycardia was more frequent in the ivabradine group than in the placebo group (22.5% vs 19.0%; RR 1.18; 95% CI 1.00-1.40).

“Ivabradine should not be used to reduce MINS in patients undergoing non-cardiac surgery,” concluded Dr Szczeklik. “The agent lowered heart rate modestly without causing hypotension.”

1. Szczeklik W, et al. Ivabradine for prevention of myocardial injury after non-cardiac surgery: PREVENT-MINS trial. Hotline 5, ESC Congress 2025, 29 August – 1 September, Madrid, Spain.

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Posted on 7 November 20257 November 2025