A Perne1, F P Schmidt1, M Hochadel2, E Giannitsis3, H Darius4, L S Maier5, C Schmitt6, G Heusch7, T Voigtländer8, H Mudra9, T Gori1, J Senges2, T Münzel10,11. 1. 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany. 2. Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg, Germany. 3. 3rd Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany. 4. Department of Cardiology, Angiology and Intensive Care Medicine, Vivantes-Klinikum Neukölln, Berlin, Germany. 5. 2nd Department of Medicine, University Hospital of Regensburg, Regensburg, Germany. 6. Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany. 7. Institute for Pathophysiology, West German Heart and Vascular Center University Duisburg-Essen, Essen, Germany. 8. CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany. 9. Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany. 10. 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany. tmuenzel@uni-mainz.de. 11. 2. Medical Clinic for Cardiology, Angiology and Intensive Care, Langenbeckstrasse 1, 55131, Mainz, Germany. tmuenzel@uni-mainz.de.
Abstract
BACKGROUND: Higher heart rates on admission have been associated with poor outcomes in patients with an acute coronary syndrome in previous cohorts. Whether such a linear relationship still exists in contemporary high-level care is unclear. METHODS: Prospectively collected data from patients presenting with myocardial infarction (MI) in centers participating in the Chest Pain Unit (CPU) Registry between December 2008 and July 2014 were analyzed. Patients were classified according to their initial heart rate (I: < 50; II: 50-69; III: 70-89; IV: ≥ 90 bpm). A total of 6,168 patients out of 30,339 patients presenting to 38 centers were included in the study. RESULTS: Patients in group IV had more comorbidities, while patients in group I more often had a history of MI. Patients in the lowest heart rate group presented significantly earlier to the hospital (4 h 31 min vs. 7 h 37 min; p < 0.05) and had the highest rate of interventions. The overall survival after 3 months was significantly worse in group IV after adjusting for baseline variables. In the subgroup analysis, heart rate was a prognostic factor in the non-ST-segment elevation MI group but not in the ST-segment elevation MI group. The correlation between heart rate and major adverse cardiac events followed a J-shaped curve with worst outcomes in the lowest and highest heart rate groups. CONCLUSION: Patients admitted to a dedicated CPU with the diagnosis of MI and a heart rate > 90 bpm experience reduced survival at 3 months despite optimal treatment. Patients with bradycardia also seem to be at increased risk for cardiovascular events despite much earlier presentation and treatment.
BACKGROUND: Higher heart rates on admission have been associated with poor outcomes in patients with an acute coronary syndrome in previous cohorts. Whether such a linear relationship still exists in contemporary high-level care is unclear. METHODS: Prospectively collected data from patients presenting with myocardial infarction (MI) in centers participating in the Chest Pain Unit (CPU) Registry between December 2008 and July 2014 were analyzed. Patients were classified according to their initial heart rate (I: < 50; II: 50-69; III: 70-89; IV: ≥ 90 bpm). A total of 6,168 patients out of 30,339 patients presenting to 38 centers were included in the study. RESULTS:Patients in group IV had more comorbidities, while patients in group I more often had a history of MI. Patients in the lowest heart rate group presented significantly earlier to the hospital (4 h 31 min vs. 7 h 37 min; p < 0.05) and had the highest rate of interventions. The overall survival after 3 months was significantly worse in group IV after adjusting for baseline variables. In the subgroup analysis, heart rate was a prognostic factor in the non-ST-segment elevation MI group but not in the ST-segment elevation MI group. The correlation between heart rate and major adverse cardiac events followed a J-shaped curve with worst outcomes in the lowest and highest heart rate groups. CONCLUSION:Patients admitted to a dedicated CPU with the diagnosis of MI and a heart rate > 90 bpm experience reduced survival at 3 months despite optimal treatment. Patients with bradycardia also seem to be at increased risk for cardiovascular events despite much earlier presentation and treatment.
Authors: P Greenland; M L Daviglus; A R Dyer; K Liu; C F Huang; J J Goldberger; J Stamler Journal: Am J Epidemiol Date: 1999-05-01 Impact factor: 4.897
Authors: Lorenzo Fácila; Pedro Morillas; Juan Quiles; Federico Soria; Alberto Cordero; Pilar Mazón; Manuel Anguita; Cándido Martín-Luengo; Jose Ramón Gonzalez-Juanatey; Vicente Bertomeu Journal: World J Cardiol Date: 2012-01-26
Authors: Felix Post; Evangelos Giannitsis; Thomas Riemer; Lars S Maier; Claus Schmitt; Burghard Schumacher; Gerd Heusch; Harald Mudra; Thomas Voigtländer; Rainer Erbel; Harald Darius; Hugo Katus; Christian Hamm; Jochen Senges; Tommaso Gori; Thomas Münzel Journal: Clin Res Cardiol Date: 2012-07-25 Impact factor: 5.460
Authors: Sripal Bangalore; Franz H Messerli; Fang-Shu Ou; Jacqueline Tamis-Holland; Angela Palazzo; Matthew T Roe; Mun K Hong; Eric D Peterson Journal: Eur Heart J Date: 2009-09-30 Impact factor: 29.983
Authors: Ioanna Kosmidou; Thomas McAndrew; Björn Redfors; Monica Embacher; José M Dizon; Roxana Mehran; Ori Ben-Yehuda; Gary S Mintz; Gregg W Stone Journal: J Am Heart Assoc Date: 2017-07-19 Impact factor: 5.501