Admission and 24-hour heart rates and in-hospital outcomes in STEMI undergoing primary PCI

Heart rate (HR) plays a central role in cardiac physiology and has been closely associated with major cardiovascular (CV) outcomes, including heart failure, ischemic heart disease, and cardiovascular mortality. However, whether HR can serve as an early predictor of in-hospital outcomes among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains unclear. This study aimed to evaluate the associations between heart rate at first medical contact (FHR), at hospital admission (AHR), and at 24 h post-admission (24 h) with adverse in-hospital outcomes.

This retrospective single-center observational study included 309 consecutive patients with STEMI who underwent PPCI between September 2018 and December 2020 at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Associations between the three HR measurements and in-hospital adverse cardiovascular events were analyzed using binary logistic regression models. Both crude models and models adjusted for conventional risk factors, biomarkers, and treatment variables were assessed.

Both AHR and 24 h were positively associated with in-hospital CV events, predominantly acute heart failure (P < 0.05), which were predominantly driven by acute heart failure. After adjusting for potential confounders, the odds of having in-hospital CV events were significantly enhanced by an increase in AHR and 24 h (odds ratio [OR]: 1.033, 95% confidence intervals [CI]: 1.008-1.060; OR: 1.037, 95% CI: 1.003-1.071, respectively). Additionally, every 5 bpm increase in AHR and 24 h was associated with an 18.6% and a 19.8% increased risk of in-hospital CV events, respectively. In contrast, FHR showed limited predictive value for such events.

Among STEMI patients undergoing PPCI, elevated admission and 24-hour heart rates are significantly associated with adverse in-hospital cardiovascular outcomes. Admission heart rate, in particular, may serve as a simple and reliable prognostic indicator for identifying patients at increased short-term risk.