Heart Injury After Surgery: A Major Concern

Myocardial injury after noncardiac surgery, or MINS, is a serious and all-too-common postoperative complication, responsible for roughly 13% of deaths within a month after surgery.

The PREVENT-MINS Trial: Dosage and Findings

In a groundbreaking study unveiled at ESC Congress 2025 in Madrid, Spain, researchers revealed that ivabradine, a medication aimed at reducing heart rate, did not lower the risk of MINS compared to a placebo. This trial focused on patients aged 45 and older, particularly those with or at risk for atherosclerotic diseases.

Why Ivabradine?

Conducted across 26 hospitals in Poland, the PREVENT-MINS trial was designed to test the theory that a high heart rate during surgery increases myocardial oxygen consumption and potentially leads to injury. While betablockers can help manage heart rate, they carry risks like hypotension and stroke. Ivabradine was deemed a promising alternative since it selectively slows heart rate.

Trial Conclusion: An Unexpected Outcome

The trial set out to enroll 2,500 participants but was halted prematurely due to interim analysis showing futility. In total, 2,101 patients were randomized, with an average age of 70, and almost half were women. The results? MINS occurred in 17% of those given ivabradine and 15.1% who received a placebo.

Controversial Results with Subgroup Analysis

Interestingly, patients with a history of coronary artery disease who received ivabradine had a higher risk of MINS compared to those on placebo, which contradicted initial hypotheses. Conversely, it showed no significant impact on those without a coronary artery disease history.

A Modest Heart Rate Reduction; Implications

While the ivabradine group showed a modest heart rate reduction of 3.2 beats per minute, clinically important bradycardia was more prevalent in this group.

Looking Forward: Need for New Strategies

Professor Wojciech Szczeklik, the study's lead investigator, emphasized the lack of efficacy of ivabradine in preventing MINS and called for further research into safer methods to manage heart stress during noncardiac surgery.

The search continues for effective strategies to safeguard patients' cardiac health in the surgical setting.