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.
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.
Authors: Eric S Ketchum; Kenneth Dickstein; John Kjekshus; Bertram Pitt; Meagan F Wong; David T Linker; Wayne C Levy Journal: Eur Heart J Acute Cardiovasc Care Date: 2013-09-11
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Authors: Julius C Heemelaar; Augustinus D G Krol; Marloes Louwerens; Saskia L M A Beeres; Eduard R Holman; Martin J Schalij; M Louisa Antoni Journal: Int J Cardiol Heart Vasc Date: 2021-06-25