Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction

Perné, Andrea; Schmidt, Frank; Hochadel, Matthias; Giannitsis, Evangelos; Darius, Harald; Maier, Lars S.; Schmitt, Claus; Heusch, Gerd; Voigtländer, Thomas; Mudra, Harald; Gori, Tommaso; Senges, Jochen; Münzel, Thomas

doi:10.1007/s00059-015-4355-7

Cited by 21 publications

(15 citation statements)

References 22 publications

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“…The revascularization strategy of 5 studies were total PCI. [2,3,5,8,15] Three studies [6,13,15] verified the J-shaped relationship between HR and mortality of patients with ACS. In despite of different HR levels, the aforementioned 3 studies all verified lower or elevated heart rate to be related to mortality of patients with ACS.…”

Section: Resultsmentioning

confidence: 99%

“…In the systemic review, 3 studies [6,13,15] showed the J-shaped relationship between heart rate and mortality of patients with ACS. Bangalore et al [13] has been evaluated that the relationship between admission heart rate and mortality followed a “J-shaped” curve, <50 bpm or >130 bpm as increased mortality compared with 60 to 69 bpm.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Antoni and his colleagues [8] has concluded that patients with a discharge HR of ≥70 bpm had a 2 times increased risk of cardiovascular mortality at 1- and 4-year follow-up compared with patients with an HR < 70 bpm. However, another study [6] prospectively enrolled 30,339 acute coronary syndromes (ACS) patients has demonstrated that admission HR >90 bpm or <50 bpm were associated with an increased risk of mortality. That means the relationship between HR and major adverse cardiac events followed a J-shaped curve with worst outcomes in the lowest and highest HR groups.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between heart rate and mortality of patients with acute coronary syndromes in the coronary intervention era

Zhan

Xiong

et al. 2016

Medicine

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Background:Most of acute coronary syndromes (ACS) were receiving intervention treatment a high overall rate of coronary angiography in the modern medical practice.Consequently, we conduct a review to determine the heart rate (HR) on the prognosis of ACS in the coronary intervention era.Methods:PubMed, EMBASE, MEDLINE, and the Cochrane Library was systematically searched up to May 2016 using the search terms “heart rate,” “acute coronary syndrome,” “acute myocardial infarction,” “ST elevation myocardial infarction,” “non-ST-segment elevation.” The outcome of interest was all-cause mortality. All analyses were performed using Review Manager.Results:Database searches retrieved 2324 citations. Eleven studies enrolling 156,374 patients were included. In-hospital mortality was significantly higher in the elevated HR group compared to the lower HR group (pooled RR 2.04, 95%CI 1.80–2.30, P < 0.0001). Individuals with elevated admission HR had increased risk of long-term mortality (Pooled RR = 1.63, 95%CI 1.27–2.10, P = 0.008) compared to lower admission HR. The pooled results showed elevated discharge and resting HR were related to increased mortality of patients with ACS (pooled RR 1.88, 95% CI 1.02–3.47, P = 0.04; pooled RR 2.14, 95%CI 1.37–3.33, P < 0.0001, respectively).Conclusion:Elevated HR may increase the mortality of ACS patients in the percutaneous coronary intervention era.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The relationship between heart rate and mortality of patients with acute coronary syndromes in the coronary intervention era

Zhan

Xiong

et al. 2016

Medicine

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“…Even a slight increase in HR can markedly increase the myocardial oxygen consumption of patients with myocardial ischemic disease and break the balance, leading to myocardial ischemia or even MI. Therefore, HR reduction can alleviate myocardial ischemic injury and decrease the mortality risk of patients with acute MI 19,20 . Many studies have demonstrated that the protective effect of dexmedetomidine on the myocardium results from HR reduction 21,22 .…”

Section: Hr Was Reduced By Dexmedetomidine Before Ischemia and After mentioning

confidence: 99%

Protective effect of dexmedetomidine against myocardial ischemia-reperfusion injury in rabbits

Ren

Li²,

Liu

et al. 2018

Acta Cir. Bras.

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1 AbstractPurpose: To investigate the influence of dexmedetomidine on myocardial ischemiareperfusion injury (IRI) in rabbits. Methods: Twenty-four New Zealand white rabbits were randomly divided into two equal-sized groups: IRI group (group IR) and dexmedetomidine group (group D). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), left ventricular diastolic pressure (LVDP), +dp/ dtmax, -dp/dtmax, and t-dp/dtmax were recorded and calculated at the following time points: before (T0) and after (T1) dexmedetomidine infusion, after 30-min ischemia (T2), and after 120-min reperfusion (T3). The levels of plasma endothelin 1 (ET-1), thromboxane A2 (TXA2), and platelet activating factor (PAF); area of myocardial infarction (MI); and no-reflow area were evaluated. Results: SBP, DBP, LVSP, LVEDP, LVDP, and +dp/dtmax at T3 were higher in group D than in group IR (P<0.05). The average no-reflow area in group IR was significantly smaller than that in group D (14±3% vs. 38±5%, P=0.0116). The ET-1, TXA2, and PAF levels at T2 and T3 were higher than those at T0 in both groups (P<0.05). Conclusion: Dexmedetomidine could reduce the magnitude of ischemic myocardial noreflow area and protect the myocardium with ischemia-reperfusion injury.

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“…Resting heart rate has been identified as a modifiable risk factor of cardiovascular outcomes in patients with coronary artery disease . During the acute phase of ST‐segment elevation myocardial infarction (STEMI), elevated admission heart rate (AHR) portends a poor short‐ and long‐term prognosis compared with a lower AHR in patients managed with thrombolytic therapy or percutaneous coronary intervention (PCI) .…”

Section: Introductionmentioning

confidence: 99%

Correlation of Admission Heart Rate With Angiographic and Clinical Outcomes in Patients With Right Coronary Artery ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: HORIZONS‐AMI (The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trial

Kosmidou

McAndrew

Redfors

et al. 2017

JAHA

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BackgroundBradycardia on presentation is frequently observed in patients with right coronary artery ST‐segment elevation myocardial infarction, but it is largely unknown whether it predicts poor angiographic or clinical outcomes in that patient population. We sought to determine the prognostic implications of admission heart rate (AHR) in patients with ST‐segment elevation myocardial infarction and a right coronary artery culprit lesion.Methods and ResultsWe analyzed 1460 patients with ST‐segment elevation myocardial infarction and a right coronary artery culprit lesion enrolled in the randomized HORIZONS‐AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial who underwent primary percutaneous coronary intervention. Patients presenting with high‐grade atrioventricular block were excluded. Outcomes were examined according to AHR range (AHR <60, 61–79, 80–99, and ≥100 beats per minute). Baseline and procedural characteristics did not vary significantly with AHR except for a more frequent history of diabetes mellitus, longer symptom‐to‐balloon time, more frequent cardiogenic shock, and less frequent restoration of thrombolysis in myocardial infarction 3 flow in patients with admission tachycardia (AHR >100 beats per minute). Angiographic analysis showed no significant association between AHR and lesion location or complexity. On multivariate analysis, admission bradycardia (AHR <60 beats per minute) was not associated with increased 1‐year mortality (hazard ratio 1.33; 95% CI 0.41–4.34, P=0.64) or major adverse cardiac events (hazard ratio 1.08; 95% CI 0.62–1.88, P=0.78), whereas admission tachycardia was a strong independent predictor of mortality (hazard ratio 5.02; 95% CI 1.95–12.88, P=0.0008) and major adverse cardiac events (hazard ratio 2.20; 95% CI 1.29–3.75, P=0.0004).ConclusionsIn patients with ST‐segment elevation myocardial infarction and a right coronary artery culprit lesion undergoing primary percutaneous coronary intervention, admission bradycardia was not associated with increased mortality or major adverse cardiac events at 1 year.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00433966.

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Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction

Cited by 21 publications

References 22 publications

The relationship between heart rate and mortality of patients with acute coronary syndromes in the coronary intervention era

The relationship between heart rate and mortality of patients with acute coronary syndromes in the coronary intervention era

Protective effect of dexmedetomidine against myocardial ischemia-reperfusion injury in rabbits

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