Daniela Dobre1, John Kjekshus2, Patrick Rossignol3, Nicolas Girerd3, Athanase Benetos4, Kenneth Dickstein5, Faiez Zannad3. 1. INSERM, Center of Clinical Investigation 1433, University Hospital Nancy, University of Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France; Department of Medical Informatics and Clinical Investigation Unit, Psychotherapeutic Center of Nancy, Laxou, France. Electronic address: daniela.dobre@cpn-laxou.com. 2. Department of Cardiology, Rikshospitalet, University of Oslo, Norway. 3. INSERM, Center of Clinical Investigation 1433, University Hospital Nancy, University of Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France. 4. Department of Geriatrics and FHU CARTAGE, University Hospital Nancy and INSERM 1116, University of Lorraine, Nancy, France. 5. University of Bergen, Stavanger University Hospital, Norway.
Abstract
OBJECTIVE: To assess the relationship between heart rate (HR), pulse pressure (PP), and their association with mortality in a population of high-risk patients following acute myocardial infarction (MI). METHODS: We performed an analysis in 22,398 patients included in "The High-Risk Myocardial Infarction Database Initiative", a database of clinical trials evaluating pharmacologic interventions in patients with MI complicated by signs of heart failure (HF) or left ventricular dysfunction. We found an interaction between HR and PP. Based on median HR and median PP, patients were divided in four categories: (1) HR < 75 bpm and PP ≥ 50 mm Hg (reference), (2) HR < 75 bpm and PP < 50 mm Hg, (3) HR ≥ 75 bpm and PP ≥ 50 mm Hg, and (4) HR ≥ 75 bpm and PP < 50 mm Hg. The association between these categories and outcomes was studied using a Cox proportional hazard model. RESULTS: After a median follow-up of 24 (18-33) months, 3561 (16%) patients died of all-causes and 3048 (14%) patients of cardiovascular (CV) causes. In multivariate analysis, patients from the fourth category had the highest risk of all-cause mortality (hazard ratio of 1.69; 95% CI: 1.53-1.86) and CV mortality (hazard ratio of 1.78; 95% CI: 1.60-1.97). CONCLUSIONS: There is an interaction between HR and PP in patients with HF following MI, with the highest risk being conferred by a clinical status with both an elevated HR and a lower PP. These findings identify a high-risk population likely to require an aggressive diagnostic and management strategy.
OBJECTIVE: To assess the relationship between heart rate (HR), pulse pressure (PP), and their association with mortality in a population of high-risk patients following acute myocardial infarction (MI). METHODS: We performed an analysis in 22,398 patients included in "The High-Risk Myocardial Infarction Database Initiative", a database of clinical trials evaluating pharmacologic interventions in patients with MI complicated by signs of heart failure (HF) or left ventricular dysfunction. We found an interaction between HR and PP. Based on median HR and median PP, patients were divided in four categories: (1) HR < 75 bpm and PP ≥ 50 mm Hg (reference), (2) HR < 75 bpm and PP < 50 mm Hg, (3) HR ≥ 75 bpm and PP ≥ 50 mm Hg, and (4) HR ≥ 75 bpm and PP < 50 mm Hg. The association between these categories and outcomes was studied using a Cox proportional hazard model. RESULTS: After a median follow-up of 24 (18-33) months, 3561 (16%) patients died of all-causes and 3048 (14%) patients of cardiovascular (CV) causes. In multivariate analysis, patients from the fourth category had the highest risk of all-cause mortality (hazard ratio of 1.69; 95% CI: 1.53-1.86) and CV mortality (hazard ratio of 1.78; 95% CI: 1.60-1.97). CONCLUSIONS: There is an interaction between HR and PP in patients with HF following MI, with the highest risk being conferred by a clinical status with both an elevated HR and a lower PP. These findings identify a high-risk population likely to require an aggressive diagnostic and management strategy.
Authors: Tripti Rastogi; Frederick K Ho; Patrick Rossignol; Thomas Merkling; Javed Butler; Andrew Clark; Timothy Collier; Christian Delles; J Wouter Jukema; Stephane Heymans; Roberto Latini; Alexandre Mebazaa; Pierpaolo Pellicori; Peter Sever; Jan A Staessen; Lutgarde Thijs; John G Cleland; Naveed Sattar; Faiez Zannad; Nicolas Girerd Journal: Eur J Heart Fail Date: 2022-04-18 Impact factor: 17.349