Prognostic Role of Heart Rate Variability in Patients with ST-Segment Elevation Acute Myocardial Infarction Treated by Primary Angioplasty

Abstract

Objectives: The aim of our study was to assess the prognostic value of heart rate variability (HRV) in ST-segment elevation acute myocardial infarction (STEMI) patients treated by percutaneous transluminal coronary angioplasty (PTCA) and optimal medical therapy. Methods: We enrolled 182 consecutive patients with a first STEMI (59.1 ± 11 years; 82.4% men) treated by primary PTCA. HRV was assessed on 24-hour Holter ECG recordings before discharge and 1 and 6 months after discharge. The primary end point was the occurrence of major clinical events (MCE), defined as death or new acute myocardial infarction (AMI). Results: At a follow-up of 42 ± 23 months, MCE occurred in 14 patients (7.6%; 3 deaths and 11 re-AMIs). HRV parameters before discharge were significantly lower in patients with MCE, with standard deviation of all RR intervals (SDNN) and very low frequency and low frequency (LF) amplitude being the most predictive variables. HRV assessed at follow-up instead did not significantly predict MCE. At multivariate analysis, only SDNN (HR 0.97; p = 0.02) and LF (HR 0.90; p = 0.04) remained significantly associated with MCE. Lower tertile SDNN and LF values were associated with a multivariate HR of 3.91 (p = 0.015) and of 2.92 (p = 0.048), respectively. Similar results were observed considering re-AMI only as the end point. Conclusions: In STEMI patients treated by PTCA, HRV assessed before discharge was an independent predictor of MCE and re-AMI.

The effects of Ramadan fasting on heart rate variability in healthy individuals: A prospective study

“…HRV was also an independent predictor of increased mortality of patients with myocardial infarction and congestive heart failure (3,4). Autonomic changes have been found to be associated with ischemia in patients with coronary artery disease (5).…”

Does heart rate variability correlate with long-term prognosis in myocardial infarction patients treated by early revascularization?

“…It is however much lower than that reported by Wiliński et al[7] in patients treated by primary PCI (21% in patients < 65 years old and 34% in those ≥ 65 years old), as well as in other smaller dimension studies in which patients had also been treated by primary PCI[9,16]. When considering the subgroup of patients with even more depressed HRV (using the cut-off of SDNN < 50 ms, as in the pivotal study by Kleiger et al[1]), the prevalence of this abnormal parameter was lower in our STEMI patients (5% in our study vs 15% in Kleiger’s study), being somehow similar to that observed also by Erdogan et al[6] (7%) in patients treated by immediate revascularization.…”

“…Almost all these studies included both STEMI and NSTEMI patients. More recently, only STEMI patients have been analysed, following treatment by primary PCI: Their long-term mortality rate was reported to be substantially lower than in the pre-primary-PCI era, being possible to calculate it on average around 5% of cases[6,9,16]. …”

Discharge after Primary Angioplasty at 24 h: Feasible and Safe or a Step Too Far?

“…Biochemical markers and other markers such as heart rate variability or white blood cell count are likely to play an increasingly important role in the future of risk stratification for early discharge [23,24,25]. …”