Ivabradine in Patients Undergoing Noncardiac Surgery: A Randomized Controlled Trial

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Perioperative beta-blockade reduces heart rate but increases risks like hypotension and stroke.
• Ivabradine, a selective heart rate-lowering agent, was investigated as a potential alternative to prevent myocardial injury after noncardiac surgery (MINS).

Purpose of the Study:

• To evaluate the efficacy of ivabradine in preventing myocardial injury after noncardiac surgery (MINS).

Main Methods:

• A multicenter, double-blind, placebo-controlled trial involving 2101 patients aged ≥45 years with or at risk of atherosclerotic disease.
• Patients received oral ivabradine or placebo for up to 7 days, starting before noncardiac surgery.
• The primary outcome was the occurrence of MINS within 30 days.

Main Results:

• MINS occurred in 17.0% of the ivabradine group versus 15.1% in the placebo group (RR, 1.12; 95% CI, 0.92 to 1.37; p=0.25).
• The trial was halted early due to futility, with conditional power at 6%.
• Ivabradine significantly lowered intraoperative heart rate but did not affect mean arterial pressure.

Conclusions:

• Ivabradine did not reduce the incidence of myocardial injury after noncardiac surgery (MINS).
• The study suggests ivabradine is not effective for preventing MINS in this patient population.