Kovar David, Cannon Christopher P, Bentley Jane H, Charlesworth Andrew, Rogers William J
Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Clin Cardiol. 2004 Feb;27(2):80-6. doi: 10.1002/clc.4960270207.
Lower admission heart rate (HR) is known to predict favorable outcome in ST-elevation acute myocardial infarction. However, there are limited short-term and no long-term data available regarding the prediction value of the initial HR in patients with the full spectrum of acute coronary syndromes (ACS). In addition, it is unknown whether the HR obtained later during hospitalization for ACS (i.e., Day 2 or 3) remains prognostically valuable.
The aim of this study was to investigate the utility of the initial and delayed HR in predicting outcome in patients with ACS.
We examined mortality at 30 days and 10 months in 10,267 patients with ACS enrolled in the oral glycoprotein IIb/IIIa inhibition with Orofiban in Patients with Unstable coronary Syndromes-Thrombolysis In Myocardial Infarction (OPUS-TIMI) 16 trial. Patients were stratified by HR and day from onset of ACS into the following groups: (1) HR < 60 beats/min, (2) HR 60-80 beats/min, (3) HR 80-100 beats/min, (4) HR > 100 beats/min; and HR obtained on (1) Day 1, (2) Day 2, and (3) Day 3.
By univariate analysis, mortality at 30 days and at 10 months increased progressively with higher HR strata (1.4 vs. 1.6 vs. 2.3 vs. 5.6%, p < 0.001, and 2.6 vs. 4.2 vs. 6.5 vs. 11.8%, p < 0.001, respectively). Elevated HR remained associated with mortality irrespective of time from onset of ACS.
Higher initial and delayed HR is highly predictive of higher short- and long-term mortality in patients with ACS. This is a simple marker that could be easily used in risk assessment.
已知较低的入院心率（HR）可预测ST段抬高型急性心肌梗死的良好预后。然而，关于急性冠状动脉综合征（ACS）全谱患者初始心率的预测价值，短期数据有限，长期数据则尚无可用。此外，ACS住院期间后期（即第2天或第3天）测得的心率是否仍具有预后价值尚不清楚。
本研究的目的是探讨初始心率和延迟心率在预测ACS患者预后中的作用。
我们在口服奥扎格雷抑制不稳定冠状动脉综合征患者糖蛋白IIb/IIIa试验-心肌梗死溶栓治疗16（OPUS-TIMI 16）试验中纳入的10267例ACS患者中，研究了30天和10个月时的死亡率。根据心率和ACS发病后的天数，将患者分为以下几组：（1）心率<60次/分钟，（2）心率60-80次/分钟，（3）心率80-100次/分钟，（4）心率>100次/分钟；以及在（1）第1天、（2）第2天和（3）第3天测得的心率。
单因素分析显示，30天和10个月时的死亡率随心率分层升高而逐渐增加（分别为1.4%对1.6%对2.3%对5.6%，p<0.001；以及2.6%对4.2%对6.5%对11.8%，p<0.001）。无论ACS发病后的时间如何，心率升高均与死亡率相关。
较高的初始心率和延迟心率高度预测ACS患者较高的短期和长期死亡率。这是一个简单的指标，可轻松用于风险评估。
