Initial heart rate and cardiovascular outcomes in patients presenting with acute coronary syndrome
Nidal Asaad1, Ayman El-Menyar, Khalid F AlHabib
1Department of Cardiology, Heart Hospital, Hamad Medical Corporation , Qatar.
Insights
Both high and low heart rates (HR) upon admission for acute coronary syndrome (ACS) indicate increased risk. Tachycardia predicts heart failure, while bradycardia is linked to higher early mortality.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Acute coronary syndrome (ACS) is a critical condition requiring prompt risk stratification.
- Heart rate (HR) is a readily available vital sign that may offer prognostic information in ACS.
Purpose of the Study:
- To evaluate the prognostic significance of on-admission heart rate (HR) in patients with acute coronary syndrome (ACS).
Main Methods:
- Retrospective analysis of 7939 ACS patients from the second Gulf Registry of Acute Coronary Events.
- Patients categorized into five HR groups: <60, 60-69, 70-79, 80-89, and ≥90 bpm.
- Comparison of patient characteristics, and hospital, one-month, and 12-month outcomes across HR groups.
Main Results:
- The majority of ACS patients (37%) presented with HR ≥ 90 bpm (tachycardia).
- Both low HR (<60 bpm, bradycardia) and high HR (≥90 bpm) groups had worse hospital outcomes.
- Tachycardia independently predicted heart failure (OR 2.2), while bradycardia independently predicted one-month mortality (OR 2.0).
Conclusions:
- On-admission heart rate is a significant predictor of outcomes in ACS.
- Both bradycardia and tachycardia are associated with adverse events and require careful management.
- Further research into managing HR extremes in ACS patients is warranted.
Objectives:
To assess the impact of on-admission heart rate (HR) in patients presenting with acute coronary syndrome (ACS).
Methods:
Data were collected retrospectively from the second Gulf Registry of Acute Coronary Events. Patients were divided according to their initial HR into: (I: < 60, II: 60-69, III: 70-79, IV: 80-89 and V: ≥ 90 bpm). Patients' characteristics and hospital and one- and 12-month outcomes were analyzed and compared.
Results:
Among 7939 consecutive ACS patients, groups I to V represented 7%, 13%, 20%, 23.5%, and 37%, respectively. Mean age was higher in groups I and V. Group V were more likely males, diabetic and hypertensive. ST-elevation myocardial infarction was the main presentation in groups I and V. Reperfusion therapies were less likely given to group V. Beta blockers were more frequently prescribed to group III in comparison to groups with higher HR. Groups I and V were associated with worse hospital outcomes. Multivariate analysis showed initial tachycardia as an independent predictor for heart failure (OR 2.2; 95%CI: 1.39-3.32), while bradycardia was independently associated with higher one-month mortality (OR 2.0; 95%CI: 1.04-3.85) CONCLUSION: The majority of ACS patients present with tachycardia. However, low or high HR is a marker of high risk that needs more attention and management.
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