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This randomized controlled trial evaluated whether ivabradine, a selective heart rate–lowering agent, reduces myocardial injury after noncardiac surgery (MINS). Despite significant intraoperative heart rate reduction without hemodynamic compromise, ivabradine did not lower MINS incidence compared to placebo. The trial was halted early for futility after enrolling 2101 patients at risk for atherosclerotic disease undergoing major noncardiac surgery.
