Resting heart rate associates with one-year risk of major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

Abstract

The study was to access the association between resting heart rate (RHR) and one-year risk of major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). Patients with ACS after PCI (n = 808) were prospectively followed-up for MACE. RHR was obtained from electrocardiogram. MACE was defined as a composite of cardiac death, nonfatal recurrent myocardial infarction, ischemic-driven revascularization, and ischemic stroke. The association between RHR and one-year risk of MACE was assessed using Cox proportional hazards regression model. Compared with patients with RHR >76 bpm, the adjusted hazard ratio (AHR) was 0.51 (95% confidence intervals [CI]: 0.23-1.14; P = 0.100) for patients with RHR < 61 bpm, and 0.44 (95%CI: 0.23-0.85; P = 0.014) for those with RHR 61-76 bpm. For patients with RHR ≥ 61 bpm, an increase of 10 bpm in RHR was associated with an increase by 38.0% in the risk of MACE (AHR: 1.38; 95% CI: 1.04-1.83; P = 0.026). ACS patients after PCI with RHR >76 bpm were at higher risk of MACE during one-year follow-up compared with patients with RHR 61-76 bpm. An elevated RHR ≥ 61 bpm was associated with increased risk of one-year MACE in ACS patients.

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

“…MACE, major adverse cardiovascular events, includes a composite of cardiac death, nonfatal recurrent myocardial infarction, ischemic-driven revascularization, and ischemic stroke. The elevated heart rate of aforementioned 2 studies were similar, >76 bpm [3] and ≥70 bpm, [18] respectively. However, the events of interesting in the 2 included studies were not the same.…”

“…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.…”

“…Three studies [5,8,17] measured the influence of discharge HR on the mortality of patients with ACS. The other 2 studies [3,18] have demonstrated the relationship between resting HR and mortality of ACS patients.…”

“…[3] Elevated resting HR increased mortality or MACE of patients with ACS (pooled RR 2.14, 95%CI 1.37–3.33, P  < 0.0001, I 2  = 0%) (Fig. 5).…”

“…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.…”