Saraiva Fatima, Antonio Natalia, Lourenço Carolina, Gonçalves Francisco, Monteiro Pedro, Gonçalves Lino, Freitas Mário, Providência Lufs A
Serviço de Cardiologia, Hospitals da Universidade de Coimbra, Coimbra, Portugal.
Rev Port Cardiol. 2010 Jul-Aug;29(7-8):1101-19.
Resting heart rate (RHR) is inversely correlated with the average life span of living beings. In coronary patients, increased RHR has been associated with rapid progression of atherosclerosis. The aim of this study was to compare in-hospital and long-term outcome of acute coronary syndromes according to patients' RHR.
We prospectively studied 1720 consecutive patients, divided into two groups according to RHR at admission: group A--RHR > or =82 bpm (n=543), and group B--RHR < 82 bpm (n=1177). Epidemiological, clinical, laboratory and therapeutic data were analyzed for both groups. Appropriate statistical tests and multivariate analysis were used to identify independent predictors of in-hospital and one-year mortality.
Group A included more women (35.9% vs. 27.0%, p < 0.001), older (68.36 +/- 12.74 vs. 66.39 +/- 12.43 years, p = 0.002), and diabetic patients (30.9% vs. 25.1%, p = 0.014) and non-smokers (85.8% vs. 81.4%, p = 0.024). They were admitted more often with ST-segment elevation myocardial infarction (31.5% vs. 21.5%, p < 0.001), presented higher Killip class at admission and had worse left ventricular ejection fraction (47.99 +/- 11.87% vs. 52.45 +/- 10.32%, p < 0.001). Peak myocardial markers, creatinine and blood glucose at admission were significantly higher in this group. Discharge medication was not statistically different. In-hospital mortality (7.7% vs. 3.3%, p < 0.001) and morbidity (10.4% vs. 4.9%, p < 0.001) and one-year mortality (21.3% vs. 9.6%, p < 0.001) and morbidity (43.9% vs. 36.4%, p = 0.009) were higher in the group with RHR > or =82 bpm. The independent predictors of in-hospital mortality were age > or =70.5 years (p = 0.001), RHR > or =82 bpm at admission (p = 0.035) and previous type 2 diabetes (p = 0.004). Age > or =69.5 years (p < 0.001) and RHR > or =82 bpm (p = 0.008) were also independent predictors of one-year mortality, together with Killip class >I (p < 0.001) and ejection fraction < or =49.5% (p < 0.001).
In our population of acute coronary syndrome patients, RHR > or =82 bpm was associated with worse short- and long-term outcome.
静息心率（RHR）与生物的平均寿命呈负相关。在冠心病患者中，RHR升高与动脉粥样硬化的快速进展有关。本研究的目的是根据患者的RHR比较急性冠脉综合征的住院及长期预后。
我们前瞻性地研究了1720例连续患者，根据入院时的RHR分为两组：A组——RHR≥82次/分钟（n = 543），B组——RHR＜82次/分钟（n = 1177）。对两组的流行病学、临床、实验室及治疗数据进行分析。采用适当的统计检验和多变量分析来确定住院及1年死亡率的独立预测因素。
A组女性更多（35.9%对27.0%，p＜0.001），年龄更大（68.36±12.74岁对66.39±12.43岁，p = 0.002），糖尿病患者更多（30.9%对25.1%，p = 0.014），非吸烟者更多（85.8%对81.4%，p = 0.024）。他们因ST段抬高型心肌梗死入院的比例更高（31.5%对21.5%，p＜0.001），入院时Killip分级更高，左心室射血分数更差（47.99±11.87%对52.45±10.32%，p＜0.001）。该组入院时心肌标志物峰值、肌酐和血糖显著更高。出院用药无统计学差异。RHR≥82次/分钟组的住院死亡率（7.7%对3.3%，p＜0.001）、发病率（10.4%对4.9%，p＜0.001）、1年死亡率（21.3%对9.6%，p＜0.001）和发病率（43.9%对36.4%，p = 0.009）更高。住院死亡率的独立预测因素为年龄≥70.5岁（p = 0.001）、入院时RHR≥82次/分钟（p = 0.035）和既往2型糖尿病（p = 0.004）。年龄≥69.5岁（p＜0.001）和RHR≥82次/分钟（p = 0.008）也是1年死亡率的独立预测因素，同时还有Killip分级＞I级（p＜0.001）和射血分数≤49.5%（p＜0.001）。
在我们的急性冠脉综合征患者群体中，RHR≥82次/分钟与更差的短期和长期预后相关。
