Importance of elevated heart rate in the very early phase of ST-segment elevation myocardial infarction: Results from the DANAMI-3 trial.
Autor: | Nepper-Christensen L; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Lønborg J; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Ahtarovski KA; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Høfsten DE; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Kyhl K; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Schoos MM; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Göransson C; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Laursen PN; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Sadjadieh G; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Ghotbi AA; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Bertelsen L; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Køber L; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Helqvist S; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Pedersen F; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Jørgensen E; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Kelbæk H; 2 Department of Cardiology, Zealand University Hospital, Denmark., Vejlstrup N; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Holmvang L; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark., Engstrøm T; 1 Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.; 3 University of Lund, Sweden. |
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Jazyk: | angličtina |
Zdroj: | European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2019 Jun; Vol. 8 (4), pp. 318-328. Date of Electronic Publication: 2018 Aug 23. |
DOI: | 10.1177/2048872618795515 |
Abstrakt: | Background: Elevated heart rate is associated with poor clinical outcome in patients with acute myocardial infarction. However, in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention the importance of elevated heart rate in the very early phase remains unknown. We evaluated the impact of elevated heart rate in the very early pre-hospital phase of ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention on cardiovascular magnetic resonance markers of reperfusion success and clinical outcome. Methods: In this DANAMI-3 substudy, 1560 ST-segment elevation myocardial infarction patients in sinus rhythm without cardiogenic shock were included in the analyses of clinical outcome and 796 patients underwent cardiovascular magnetic resonance to evaluate area at risk, infarct size and left ventricular ejection fraction. Heart rate was assessed on the first electrocardiogram with ST-elevation (time of diagnosis). Results: Despite equal area at risk (33%±11 versus 36%±16, p =0.174) patients with a pre-hospital heart rate ⩾100 beats per minute developed larger infarcts (19% (interquartile range, 9-17) versus 11% (interquartile range, 10-28), p =0.001) and a lower left ventricular ejection fraction (54%±12 versus 58%±9, p =0.047). Pre-hospital heart rate ⩾100 beats per minute was independently associated with an increased risk of all-cause mortality and heart failure (hazard ratio 2.39 (95% confidence interval 1.58-3.62), p <0.001). Conclusions: Very early heart rate ⩾100 beats per minute in ST-segment elevation myocardial infarction was independently associated with larger infarct size, reduced left ventricular ejection fraction and an increased risk of all-cause mortality and heart failure, and thus serves as an easily obtainable and powerful tool to identify ST-segment elevation myocardial infarction patients at high risk. |
Databáze: | MEDLINE |
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