Admission heart rate predicts mortality following primary percutaneous coronary intervention for ST-elevation
Awsan Noman1, Karthik Balasubramaniam, Rajiv Das
1Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, UK.
Insights
Elevated admission heart rate in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) predicts long-term mortality. Beta-blocker therapy improved survival in high-heart rate patients post-discharge.
Area of Science:
- Cardiology
- Clinical Medicine
- Morbidity and Mortality Studies
Background:
- The prognostic significance of admission heart rate (HR) for long-term mortality in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) requires further elucidation.
- Modern treatment strategies for STEMI have evolved, necessitating re-evaluation of established prognostic markers.
Purpose of the Study:
- To determine the predictive value of admission HR for long-term mortality in STEMI patients treated with PPCI.
- To investigate the impact of beta-blocker therapy on postdischarge survival in relation to admission HR.
Main Methods:
- Retrospective analysis of prospectively collected data from 2310 STEMI patients treated with PPCI.
- Patients were stratified into low (≤70 bpm) and high (>70 bpm) admission HR groups.
- Cox proportional hazard models were used to assess mortality risk and the effect of beta-blockers.
Main Results:
- Higher admission HR (>70 bpm) was associated with significantly increased long-term all-cause mortality (12.7% vs 7.0% in low HR group).
- Each 10-bpm increase in admission HR correlated with a 17% rise in all-cause mortality.
- Beta-blocker therapy at discharge reduced postdischarge mortality in the high HR group (aHR 0.49) but not in the low HR group (aHR 0.74).
Conclusions:
- Admission heart rate is a significant independent predictor of long-term mortality in STEMI patients receiving PPCI.
- Beta-blocker treatment is beneficial for improving postdischarge survival specifically in STEMI patients with elevated admission heart rates.
Background:
The prognostic value of admission heart rate (HR) on long-term mortality in ST-elevation myocardial infarction (STEMI) remains uncertain in the modern era of primary percutaneous coronary intervention (PPCI). This study aimed to assess the predictive value of admission HR on long-term mortality following PPCI and the influence of beta-blockers on postdischarge survival.
Methods:
Retrospective analysis of prospectively collected data on 2310 PPCI-treated STEMI patients at a regional tertiary center between March 2008 and June 2010.
Results:
Patients were classified according to admission HR into either low (≤70 beat per minute [bpm], n = 1015) or high HR group (>70 bpm, n = 1295). At a median follow-up of 559 days, all-cause mortality was 7.0% in the low HR group compared to 12.7% in the high-HR group. In the Cox proportional hazard model, adjusted for several confounders, the hazard ratio (95% confidence interval) for all-cause mortality in the high HR group was 1.59 (1.15-2.20; P = 0.005). Every 10-bpm increase in admission HR was associated with 17% increase in all-cause mortality. Beta-blockers on discharge was associated with a reduction in postdischarge mortality only in the high HR group (adjusted hazard ratio, 0.49 [0.31-0.77; P = 0.002]), but not in the low HR group (adjusted hazard ratio, 0.74 [0.37-1.49; P = 0.33]).
Conclusions:
Elevated admission heart rate in PPCI-treated STEMI patients is associated with long-term all-cause mortality. Beta blocker therapy improved postdischarge survival in patients with elevated admission heart rate.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Heart Failure I: Introduction
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...