Relationship between discharge heart rate and mortality in patients after acute myocardial infarction treated with primary percutaneous coronary intervention
Aims: In patients with coronary artery disease, the prognostic value of heart rate has been mainly evaluated in patients with left ventricular dysfunction. Patients with ST-segment elevation acute myocardial infarction (STEMI) are currently treated with primary percutaneous coronary intervention (PCI) and in this contemporary population of patients, the relationship between heart rate and mortality during a follow-up >1 year has not been investigated. Methods and results: The population comprised 1453 STEMI patients treated with primary PCI. Resting heart rate was measured before discharge and all patients were followed prospectively. Main outcome measure: the endpoints were defined as all-cause mortality and cardiovascular mortality. The median follow-up duration was 40 months. During this period, 83(6%) patients died of which 52(4%) died from cardiovascular disease. After adjusting for parameters reflecting a greater infarct size and the presence of heart failure, heart rate at discharge remained a strong predictor of mortality. Patients with a heart rate of <70 b.p.m. had a two times increased risk of cardiovascular mortality at 1- and 4-year follow-up compared with patients with a heart rate <70 b.p.m.. In addition, every increase of 5 b.p.m. in heart rate at discharge was associated with a 29 and 24% increased risk of cardiovascular mortality at 1- and 4-year follow-up, respectively. Conclusion: In STEMI patients treated with primary PCI and optimal medical therapy, heart rate at discharge was an important predictor of mortality up to 4 years follow-up even after adjustment for parameters reflecting a greater infarct size and the presence of heart failure. Published on behalf of the European Society of Cardiology. All rights reserved.
|Keywords||Heart rate, Long-term mortality, ST-segment elevation acute myocardial infarction|
|Persistent URL||dx.doi.org/10.1093/eurheartj/ehr293, hdl.handle.net/1765/71237|
|Journal||European Heart Journal|
Antoni, M.L, Boden, H, Delgado, V, Boersma, H, Fox, K, Schalij, M.J, & Bax, J.J. (2012). Relationship between discharge heart rate and mortality in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. European Heart Journal, 33(1), 96–102. doi:10.1093/eurheartj/ehr293