Prognostic impact of mean heart rate by Holter monitoring on long-term outcome in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

Shen, Jian; Liu, Gang; Yang, Yuan; Li, Xiang; Zhu, Yuansong; Xiang, Zhenxian; Gan, Hongbo; Huang, Bi; Luo, Suxin

doi:10.1007/s00392-021-01806-1

Cited by 3 publications

(4 citation statements)

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“…The higher value of blood pressure on admission indicates a preserved systolic ventricular function with less myocardial damage [ 29 ]. HR is a fundamental physiological parameter, and elevated heart rate might reflect the myocardial dysfunction, sympathetic excitation and systemic increase in oxygen consumption after STEMI, and associated with the higher risk of in-hospital mortality [ 30 ]. SBP and HR are easily determinable clinical parameters and have been adopted in numerous scores [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients

Wang,

Zhang,

et al. 2024

Annals of Medicine

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Background The incidence of mortality is considerable after ST-elevation myocardial infarction (STEMI) hospitalization; risk assessment is needed to guide postdischarge management. Age shock index (SI) and age modified shock index (MSI) were described as useful prognosis instruments; nevertheless, their predictive effect on short and long-term postdischarge mortality has not yet been sufficiently confirmed. Methods This analysis included 3389 prospective patients enrolled from 2016 to 2018. Endpoints were postdischarge mortality within 30 days and from 30 days to 1 year. Hazard ratios (HRs) were evaluated by Cox proportional-hazards regression. Predictive performances were assessed by area under the curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision curve analysis (DCA) and compared with TIMI risk score and GRACE score. Results The AUCs were 0.753, 0.746 for age SI and 0.755, 0.755 for age MSI for short- and long-term postdischarge mortality. No significant AUC differences and NRI were observed compared with the classic scores; decreased IDI was observed especially for long-term postdischarge mortality. Multivariate analysis revealed significantly higher short- and long-term postdischarge mortality for patients with high age SI (HR: 5.44 (2.73–10.85), 5.34(3.18–8.96)), high age MSI (HR: 4.17(1.78–9.79), 5.75(3.20–10.31)) compared to counterparts with low indices. DCA observed comparable clinical usefulness for predicting short-term postdischarge mortality. Furthermore, age SI and age MSI were not significantly associated with postdischarge prognosis for patients who received fibrinolysis. Conclusions Age SI and age MSI were valuable instruments to identify high postdischarge mortality with comparable predictive ability compared with the classic scores, especially for events within 30 days after hospitalization.

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Section: Discussionmentioning

confidence: 99%

Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients

Wang,

Zhang,

et al. 2024

Annals of Medicine

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“…Kurgansky et al reported that high pulse rate, both at the time of diagnosis and during follow-up, is strongly associated with increased risk of adverse outcomes in in heart failure patients with reduced ejection fraction [ 11 ]. Shen et al found that a higher mean heart rate was independently associated with an increased risk of long-term all-cause mortality in patients with ST-segment elevation myocardial infarction [ 12 ]. Therefore, the reduction of heart rate is a clinically meaningful goal.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for complications in echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation

Wang,

Cheng,

Chen

et al. 2024

J Cardiothorac Surg

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Background The feasibility of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) for the treatment of hypertrophic obstructive cardiomyopathy (HOCM) has been previously reported. However, limited investigation has been conducted regarding the complications associated with this procedure. Objective This study aims to analyze the risk factors affecting the occurrence of complications during PIMSRA, such as pericardial effusion, ventricular premature beats, and interventricular septal perforation. In this study, the optimal cut-off values for these risk factors are also explored, and corresponding strategies for prevention are proposed. Methods A total of 101 patients diagnosed with HOCM who underwent the PIMSRA procedure from 2021 to 2022 were included in this retrospective analysis. Patients were classified into subgroups with or without complications based on procedural records. Univariate and multivariate regression analyses were conducted to identify independent risk factors for complications during the PIMSRA procedure. Results There were 48 patients with complications and 53 patients without complications. The heart rate at the start of the procedure and the maximum left ventricular outflow tract gradient (LVOTG) were independent risk factors related to PIMSRA complications. The optimal cut-off values for predicting complication occurrence were a heart rate > 49 bpm at the start of the procedure (OR: 3.79, 95% CI: 1.64–8.78, p = 0.002) and a maximum LVOTG > 92 mmHg (OR: 2.57, 95% CI: 1.15–5.75, p = 0.022), respectively. Conclusions The occurrence of PIMSRA complications is primarily associated with the heart rate at the start of the procedure and the maximum LVOTG. It is recommended to establish a comprehensive control plan to minimize the risk of complications during PIMSRA procedures.

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“…Clinical trials with the following inclusion criteria were included: [1] Ivabradine used in STEMI patients and published in English; [2] Effect and safety of Ivabradine compared to non-Ivabradine group, with or without standard optimal medical treatment, including beta-blockers, antithrombotic agents, lipid-lowering agents, nitrates, renin-angiotensin system (RAS) inhibitors; [3] Pre-and post-treatment echocardiographic assessment (Additional file 1: Table S1). The exclusion criteria were as follows: (1) Non-human studies; (2) Articles in a language other than English; (3) No follow-up data; (4) Non-AMI, including old myocardial infarction and CCS; (4) No comparison between intervention and control groups (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…The current guideline recommends a target heart rate (HR) of 50-60 beats per minute (bpm) for patients with unstable angina [1]; however, there is no clear guidance on target HR in patients with acute ST-elevation myocardial infarction (STEMI). Several studies have demonstrated that higher HR after acute myocardial infarction (AMI) is associated with increased mortality, indicating that HR control could benefit patients with AMI [2,3].…”

Section: Introductionmentioning

confidence: 99%

Ivabradine in patients with acute ST-elevation myocardial infarction: a meta-analysis of randomized controlled trials

et al. 2023

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Background Elevated resting heart rate (HR) predicts poor outcomes in patients with coronary artery disease. Ivabradine has been recommended as a second-line anti-anginal agent in chronic coronary syndrome, while there are no clear indications for acute ST-elevation myocardial infarction (STEMI). Results We systematically searched PubMed, Medline, EMBASE, Clinical Trials.gov, and the Cochrane Central Register of Controlled Trials with search terms Ivabradine and Acute myocardial infarction. There are two study outcomes from this study: therapeutic and safety effects. Therapeutic effects include the efficacy of Ivabradine on HR, all-cause mortality, heart failure incidence, left ventricular function and remodeling. Safety effects include troponin levels and ischemic events (recurrent angina pectoris). A total of 6 RCTs was included and showed that Ivabradine was associated with greater resting HR reduction [MD − 5.40; 95%CI − 8.60, − 2.20], improvement of left ventricular ejection fraction [MD 2.98; 95%CI 0.44, 5.51], and left ventricular end systolic volume [MD − 3.81; 95%CI − 6.88, − 0.75]. However, Ivabradine had no impact on all-cause mortality [OR 0.76; 95%CI 0.35, 1.67], heart failure incidence [OR 0.61; 95%CI 0.21, 1.80], and recurrent angina pectoris [OR 0.71; 95%CI 0.50, 1.00]. Conclusions Ivabradine is safe and effective for resting HR reduction in patients with STEMI; however, it has no significant influence on mortality. These results suggest that an elevated HR is only a marker of risk but not a modifiable determinant of outcomes in patients who have suffered an acute myocardial infarction.

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Prognostic impact of mean heart rate by Holter monitoring on long-term outcome in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

Cited by 3 publications

References 46 publications

Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients

Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients

Analysis of risk factors for complications in echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation

Ivabradine in patients with acute ST-elevation myocardial infarction: a meta-analysis of randomized controlled trials

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