Ivabradine Fails To Prevent Myocardial Injury After Noncardiac Surgery In Large Clinical Trial

Ivabradine did not trim nan occurrence of myocardial wounded aft noncardiac room (MINS), according to late-breaking investigation presented successful a Hot Line convention coming astatine ESC Congress 2025.

MINS is simply a communal and superior complication, which has been recovered to relationship for astir 13% of each deaths wrong 30 days of surgery. Explaining nan rationale of nan PREVENT-MINS trial, Principal Investigator, Professor Wojciech Szczeklik from Jagiellonian University Medical College, Krakow, Poland, said: "It has been projected that accrued bosom complaint astatine nan clip of room leads to higher myocardial oxygen consumption, a supply-demand mismatch and myocardial injury. Giving beta-blockers astir nan clip of room lowers bosom complaint and decreases nan consequence of myocardial infarction, but these benefits whitethorn beryllium offset by accrued consequence of hypotension, decease and stroke. Ivabradine is simply a presently disposable medicine utilized successful angina and bosom nonaccomplishment that much selectively slows bosom complaint than beta-blockers. The PREVENT-MINS proceedings assessed whether ivabradine could forestall MINS successful patients aft noncardiac room with, aliases astatine consequence of, atherosclerotic disease."

The double-blind, placebo-controlled, randomized PREVENT-MINS proceedings was conducted astatine 26 hospitals successful Poland. Eligible patients were aged ≥45 years and had either established atherosclerotic illness (i.e. coronary artery disease, peripheral artery illness aliases anterior stroke) aliases important consequence factors for atherosclerotic illness (e.g. diabetes, hypertension and property ≥70 years). Patients were randomised 1:1 to person ivabradine (5 mg orally doubly regular for up to 7 days, starting 1 hr earlier surgery) aliases placebo. The superior result was MINS wrong 30 days from randomization. The proceedings had intended to enrol astir 2,500 patients; however, nan independent Data Monitoring Committee recommended early termination successful March 2025 for futility, based connected nan prespecified interim analysis.

All 2,101 participants who underwent randomization were included successful nan intention-to-treat population. The median property was 70.0 years and 49.4% were women.

MINS occurred successful 17.0% of patients successful nan ivabradine group and 15.1% successful nan placebo group (relative consequence [RR] 1.12; 95% assurance interval [CI] 0.92 to 1.37; p=0.25). In prespecified subgroup analyses, ivabradine was associated pinch an accrued consequence of MINS among patients pinch a history of coronary artery illness (RR 1.49; 95% CI 1.03 to 2.16) but not among patients without a history of coronary artery illness (RR 0.98; 95% CI 0.78 to 1.24).

The intraoperative mean bosom complaint was little successful nan ivabradine group by 3.2 thumps per infinitesimal than successful nan placebo group, pinch nary quality successful intraoperative mean arterial pressure. Clinically important bradycardia was much communal successful nan ivabradine group (RR 1.18; 95% CI 1.00 to 1.40).

Ivabradine did not trim nan consequence of MINS successful patients undergoing noncardiac surgery. Heart-rate lowering was humble and nan imaginable higher MINS incidence successful patients pinch known coronary artery illness is contrary to our original hypothesis. Further investigation is needed to found a method to safely power nan heart's accent associated pinch noncardiac surgery."

Professor Wojciech Szczeklik, Jagiellonian University Medical College, Krakow, Poland