Admission Heart Rate Predicts Mortality Following Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: An Observational Study

Abstract

SUMMARYBackground: The prognostic value of admission heart rate (HR) on long-term mortality in ST-elevation myocardial infarction (STEMI) remains uncertain in the modern era of primary percutaneous coronary intervention (PPCI). This study aimed to assess the predictive value of admission HR on long-term mortality following PPCI and the influence of betablockers on postdischarge survival. Methods: Retrospective analysis of prospectively collected data on 2310 PPCI-treated STEMI patients at a regional tertiary center between March 2008 and June 2010. Results: Patients were classified according to admission HR into either low ( 70 beat per minute [bpm], n = 1015) or high HR group (>70 bpm, n = 1295). At a median follow-up of 559 days, all-cause mortality was 7.0% in the low HR group compared to 12.7% in the high-HR group. In the Cox proportional hazard model, adjusted for several confounders, the hazard ratio (95% confidence interval) for all-cause mortality in the high HR group was 1.59 (1.15-2.20; P = 0.005). Every 10-bpm increase in admission HR was associated with 17% increase in all-cause mortality. Beta-blockers on discharge was associated with a reduction in postdischarge mortality only in the high HR group (adjusted hazard ratio, 0.49 [0.31-0.77; P = 0.002]), but not in the low HR group (adjusted hazard ratio, 0.74 [0.37-1.49; P = 0.33]). Conclusions: Elevated admission heart rate in PPCI-treated STEMI patients is associated with long-term all-cause mortality. Beta blocker therapy improved postdischarge survival in patients with elevated admission heart rate.

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

“…According to the inclusion criteria, 11 studies enrolling 156,374 patients were eventually include in the systemic review. Six studies [2,6,13–16] showed the relationship between admission HR and mortality of patients with ACS. Three studies [5,8,17] measured the influence of discharge HR on the mortality of patients with ACS.…”

“…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.…”

“…However, most of the included studies have regarded >70 to 80 bpm as the elevated HR. [2,3,8,15–18] Therefore, >70 to 80 bpm should be identified as the risk factor for mortality of ACS patients.…”

“…[1–7] Diaz et al [1] has explored that patients suspected or proven coronary artery diseases (CAD) with resting HR > 83 bpm had a significantly higher risk for total mortality and cardiovascular mortality when compared with the HR ≤62 bpm group. In the modern era of primary percutaneous coronary intervention, an observational study [2] has showed that hazard ratio for all-cause mortality in the elevated admission HR group (>70 bpm) was 1.59 for STEMI patients when compared with patients with an HR ≤70 bpm. 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.…”

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

“…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) . Elevated AHR is often associated with anterior infarcts; however, it is unknown whether the frequently observed sinus or junctional bradycardic response in the setting of inferior STEMI confers clinical benefit or risk in that patient population.…”