Only the study team can determine whether someone qualifies for participation.
Inclusion criteria
- Undergoing noncardiac surgery
- ≥45 years of age
- Expected to require at least an overnight hospital admission after surgery
- Provide written informed consent to participate in the PREVENT-MINS Trial, AND
- Fulfill ≥1 of the following 5 criteria (A-E):
A. History of coronary artery disease B. History of peripheral arterial disease C. History of stroke D. Undergoing major vascular surgery, OR
E. Any 3 of 9 risk criteria:
i. Undergoing major surgery ii. History of congestive heart failure iii. History of a transient ischaemic attack iv. Diabetes and currently taking an oral hypoglycemic agent or insulin v. Age ≥70 years vi. History of hypertension vii. Serum creatinine >175 µmol/L (>2.0 mg/dl) viii. History of smoking within 2 years of surgery ix. Undergoing emergent/urgent surgery
Exclusion criteria
- Conduction abnormalities:
A. Non-sinus rhythm on ECG B. Sinoatrial or AV (2nd and 3d degree) blocks C. Sick sinus syndrome D. Long QT syndrome E. Pacemaker dependent
- Transplanted heart (or on waiting list)
- Use of a selected class I or III antiarrhythmic drug (quinidine, disopyramide, sotalol, ibutilide, amiodarone) or diltiazem/verapamil
- Resting heart rate <65 beats per minute on the day of surgery
- Systolic blood pressure <90 mmHg on the day of surgery
- Acute decompensated heart failure, cardiogenic shock, acute myocarditis
- Acute coronary syndrome within 2 months before surgery;
- Stroke or transient cerebral ischaemia within 1 month before surgery
- Known severe liver or kidney disease (MDRD creatinine clearance <15 mL/min)
- Inability to tolerate oral intake
- Recent use of ivabradine (<1 month)
- Known allergy or hypersensitivity to ivabradine
- Low-risk surgical procedure based on individual physician's judgment
- Investigator considers the patient unreliable regarding requirement for study compliance
- Women of childbearing potential who are not taking effective contraception, pregnant or breast-feeding
- Previously enrolled in the PREVENT-MINS study
