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Published on: March 27, 2018
No Association of Early Postoperative Heart Rate With Outcomes After Coronary Artery Bypass Grafting
Yoshihisa Morita1, Junji Kumasawa2, Yoshihisa Miyamoto3
1Yoshihisa Morita is an assistant professor, Department of Anesthesiology, University of Maryland Medical Center, Baltimore, Maryland.
Insights
Elevated postoperative heart rate after coronary artery bypass grafting (CABG) was not significantly associated with major adverse cardiac and cerebrovascular events (MACCEs). Further research is needed to determine the clinical utility of heart rate monitoring in CABG patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Elevated perioperative heart rate may lead to myocardial injury due to oxygen supply-demand imbalance.
- Large-scale studies on early postoperative heart rate and major adverse cardiac and cerebrovascular events (MACCEs) are limited.
Purpose of the Study:
- To investigate the association between four postoperative heart rate assessment methods and in-hospital MACCEs following elective coronary artery bypass grafting (CABG).
Main Methods:
- Utilized data from the eICU Collaborative Research Database (2014-2015) for 2585 patients undergoing CABG.
- Assessed postoperative heart rate within 24 hours of intensive care unit admission using four methods: maximum heart rate, duration above 100 bpm, area above 100 bpm, and time-weighted average heart rate.
- Defined in-hospital MACCEs as a composite outcome including death, myocardial infarction, angina, arrhythmia, heart failure, stroke, cardiac arrest, or repeat revascularization.
Main Results:
- The overall incidence of in-hospital MACCEs was 6.2%.
- Multivariable logistic regression revealed no significant association between maximum heart rate categories (e.g., >130 bpm: OR 1.71, 95% CI 0.80-3.35) and MACCEs.
- None of the other three heart rate assessment methods demonstrated a significant association with MACCEs.
Conclusions:
- Current methods of assessing early postoperative heart rate did not show a significant association with in-hospital MACCEs in CABG patients.
- Further research is required to establish the clinical value of heart rate monitoring in the early postoperative period for patients after CABG.
Background:
Elevated perioperative heart rate potentially causes perioperative myocardial injury because of imbalance in oxygen supply and demand. However, large multicenter studies evaluating early postoperative heart rate and major adverse cardiac and cerebrovascular events (MACCEs) are lacking.
Objective:
To assess the associations of 4 postoperative heart rate assessment methods with in-hospital MACCEs after elective coronary artery bypass grafting (CABG).
Methods:
Using data from the eICU Collaborative Research Database in the United States from 2014 to 2015, the study evaluated postoperative heart rate measured during hospitalization within 24 hours after intensive care unit admission. Four heart rate assessment methods were evaluated: maximum heart rate, duration above heart rate 100/min, area above heart rate 100/min, and time-weighted average heart rate. The outcome was in-hospital MACCEs, defined as a composite of in-hospital death, myocardial infarction, angina, arrhythmia, heart failure, stroke, cardiac arrest, or repeat revascularization.
Results:
Among 2585 patients, the crude rate of in-hospital MACCEs was 6.2%. In multivariable logistic regression analysis, the adjusted odds ratios (95% CI) for in-hospital MAC-CEs assessed by maximum heart rate in each heart rate category (beats per minute: >100-110, >110-120, >120-130, and >130) were 1.43 (0.95-2.15), 0.98 (0.56-1.64), 1.47 (0.76-2.69), and 1.71 (0.80-3.35), respectively. Similarly, none of the other 3 methods were associated with MACCEs.
Conclusions:
More research is needed to assess the usefulness of heart rate measurement in patients after CABG.
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