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Heart rate as an independent prognostic risk factor in patients with acute myocardial infarction undergoing primary

Guido Parodi1, Benedetta Bellandi, Renato Valenti

  • 1Division of Cardiology, Careggi Hospital, Viale Morgagni 85, I-50134 Florence, Italy. parodiguido@gmail.com

Atherosclerosis
|March 16, 2010
PubMed

Insights

Elevated heart rate (80 bpm or greater) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) indicates a higher risk of death. This finding highlights heart rate as a critical prognostic marker in STEMI management.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Interventional Cardiology

Background:

  • Elevated heart rate is a known risk factor for adverse cardiovascular outcomes in patients with coronary artery disease and left ventricular dysfunction.
  • Prognostic markers are crucial for risk stratification in acute myocardial infarction (MI).

Purpose of the Study:

  • To evaluate the prognostic significance of presenting heart rate in patients with ST-elevation acute myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

Main Methods:

  • A cohort of 2477 consecutive STEMI patients treated with primary PCI was analyzed.
  • Patients were categorized into heart rate groups: <60 bpm, 60-79 bpm, and ≥80 bpm.
  • Cox proportional hazard models were used to assess the association between baseline heart rate and cardiovascular outcomes, excluding patients with arrhythmias.

Main Results:

  • A baseline heart rate of 80 bpm or greater was independently associated with a significantly increased risk of mortality (Hazard Ratio [HR] 2.170, p=0.0001).
  • For every 5 bpm increase in heart rate, mortality risk increased (HR 1.321, p=0.0001).
  • Age, cardiogenic shock, prior MI, peak creatine-kinase, and optimal PCI result were also significant predictors of mortality.

Conclusions:

  • In STEMI patients undergoing primary PCI, a presenting heart rate of 80 bpm or higher identifies individuals at increased risk of death.
  • The potential benefit of heart rate reduction on outcomes in this patient population remains to be determined.
Abstract

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