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Title: Heart Rate as a Predictor of Outcome Following Percutaneous Coronary Intervention.
Austin Authors: O'Brien, Jessica;Reid, Christopher M;Andrianopoulos, Nick;Ajani, Andrew E;Clark, David J ;Krum, Henry;Loane, Philippa;Freeman, Melanie;Sebastian, Martin;Brennan, Angela L;Shaw, James;Dart, Anthony M;Duffy, Stephen J
Affiliation: Department of Cardiology, the Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
Department of Cardiology, Geelong Hospital, Victoria, Australia
Department of Cardiology, Alfred Hospital, Victoria, Australia
Department of Cardiology, University of Melbourne, Victoria, Australia
Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiology, Box Hill Hospital, Victoria, Australia
Issue Date: 4-Jul-2018 2018-07-04
Publication information: The American journal of cardiology 2018; 122(7): 1113-1120
Abstract: Data from previous studies of patients with heart failure and coronary artery disease suggest that those with higher resting heart rates (HRs) have worse cardiovascular outcomes. We sought to evaluate whether HR immediately before percutaneous coronary intervention (PCI) is an independent predictor for 30-day outcome. We analyzed the outcome of 3,720 patients who had HR recorded before PCI from the Melbourne Interventional Group registry. HR and outcomes were analyzed by quintiles, and secondarily by dichotomizing into <70 or ≥70 beats/min. Patients with cardiogenic shock, intra-aortic balloon pump or inotropic support, and out-of-hospital arrest were excluded. The mean ± SD HR was 70.9 ± 14.7 beats/min. HR by quintile was 55 ± 5, 64 ± 2, 70 ± 1, 77 ± 3, and 93 ± 13 beats/min, respectively. Patients with higher HR were more likely to be women, current smokers, have higher systolic and diastolic blood pressure, atrial fibrillation, recent heart failure, lower ejection fraction, and ST-elevation myocardial infarction as the indication for the PCI (all p ≤0.002). However, rates of treated hypertension, multivessel disease, previous myocardial infarction, PCI, and coronary bypass surgery were lower (all p ≤0.004). Increased HR was associated with higher 30-day mortality (p for trend = 0.04), target vessel revascularization (p for trend = 0.003), and 30-day major adverse cardiac events (MACE) (p for trend = 0.004). In a multivariable analysis, HR was an independent predictor of 30-day MACE (OR 1.21 per quintile; 95% confidence interval (CI): 1.06 to 1.39, p = 0.004). When dichotomized into <70 or ≥70 beats/min, HR independently predicted both 30-day MACE (OR 1.59, 95% CI 1.08 to 2.36, p = 0.02) and 30-day mortality (OR 2.80, 95% CI 1.10 to 7.08, p = 0.03). In conclusion, HR immediately before PCI is an independent predictor of adverse 30-day cardiovascular outcomes.
DOI: 10.1016/j.amjcard.2018.06.042
PubMed URL: 30107905
Type: Journal Article
Appears in Collections:Journal articles

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