Prognostic value of low heart rates in patients admitted with acute myocardial infarction.

Autor: Biasco L; Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland. Electronic address: https://twitter.com/@BiascoDr., Foster-Witassek F; AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Radovanovic D; AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Dittli P; Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland., Tersalvi G; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Division of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: https://twitter.com/@GTersalvi., Rickli H; Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland., Roffi M; Division of Cardiology, University Hospital of Geneva, Geneva, Switzerland., Eberli F; Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland., Jeger R; Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland., Erne P; AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Pedrazzini G; Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland. Electronic address: giovanni.pedrazzini@eoc.ch.
Jazyk: English; Spanish; Castilian
Zdroj: Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2023 Aug; Vol. 76 (8), pp. 626-634. Date of Electronic Publication: 2023 Feb 04.
DOI: 10.1016/j.rec.2023.01.008
Abstrakt: Introduction and Objectives: The risk prediction scores adopted in acute coronary syndromes (ACS) use incremental models to estimate mortality for heart rate (HR) above 60 bpm. Nonetheless, previous studies reported a nonlinear relationship between HR and events, suggesting that low HR may have an unrecognized prognostic role. We aimed to assess the prognostic impact of low HR in ACS, defined as admission HR <50 bpm.
Methods: This study analyzed data from the AMIS Plus registry, a cohort of hospitalized patients with ACS between 1999 and 2021. The primary endpoint was in-hospital all-cause mortality, while a composite of all-cause mortality, major cardiac/cerebrovascular events was set as the secondary endpoint. A multilevel statistical method was used to assess the prognostic role of low HR in ACS.
Results: The study included 51 001 patients. Crude estimates showed a bimodal distribution of primary and secondary endpoints with peaks at low and high HR. A nonlinear relationship between HR and in-hospital mortality was observed on restricted cubic spline analysis. An HR of 50 to 75 bpm showed lower mortality than HR <50 bpm (OR, 0.67; 95%CI, 0.47-0.99) only after primary multivariable analysis, which was not confirmed after multiple sensitivity analyses. After propensity score matching, progressive fading of the prognostic role of HR <50 bpm was evident.
Conclusions: Low admission HR in ACS is associated with a higher crude rate of adverse events. Nonetheless, after correction for baseline differences, the prognostic role of low HR was not confirmed. Therefore, low HR probably represents a marker of underlying morbidity. These results may be clinically relevant in improving the accuracy of risk scores in ACS.
(Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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