Stępińska Janina, Marona Miłosz, Greenlaw Nicola, Steg Gabriel
Institute of Cardiology, Department of Cardiac Intensive Care, Warsaw, Poland.
Kardiol Pol. 2014;72(11):1156-64. doi: 10.5603/KP.a2014.0134. Epub 2014 Jul 8.
Heart rate (HR) is an important risk factor in coronary artery disease (CAD). However, there is little contemporary data on HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice.
To describe HR in the Polish population of the CLARIFY registry, overall and in relation to beta-blocker use, and to assess the determinants of HR.
CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as either prior myocardial infarction or revascularisation procedure, or evidence of coronary stenosis of at least 50%, or chest pain associated with proven myocardial ischaemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, the Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. In Poland, 1,004 patients were enrolled between February and June 2010, which was the largest population among countries from Eastern Europe. Most patients were men (72.8%). Mean ± standard deviation age was 62.1 ± 9.1 years. HR determined by pulse was 69.3 ± 9.4 bpm and by electrocardiogram was 68.2 ± 10.6 bpm. Beta-blockers were used in 89.9% of patients. Resting HR ≥ 70 bpm was noted in 49.3% of all patients and in 48.6% of patients on beta-blockers. Resting HR ≥ 70 bpm was significantly more frequent among younger patients, and in those with diabetes, those being treated for arterial hypertension, and who lacked regular physical activity. Patients with HR ≥ 70 bpm at rest had more frequent symptoms of angina and more frequently needed hospitalisation due to heart failure.
Despite a very high rate of beta-blocker use, almost 50% of patients with stable CAD had a resting HR ≥ 70 bpm, which was associated with more frequent angina and ischaemia. Further HR lowering is possible in many patients with CAD. Whether or not this will improve symptoms and outcomes is under investigation.
心率（HR）是冠状动脉疾病（CAD）的一项重要危险因素。然而，在日常临床实践中，关于稳定型CAD患者的心率以及降低心率药物（尤其是β受体阻滞剂）使用情况的当代数据较少。
描述波兰CLARIFY注册研究人群的心率，包括总体心率以及与β受体阻滞剂使用相关的心率，并评估心率的决定因素。
CLARIFY是一项针对稳定型CAD门诊患者的国际前瞻性观察性纵向注册研究，稳定型CAD定义为既往心肌梗死或血运重建手术、冠状动脉狭窄至少50%的证据、或与证实的心肌缺血相关的胸痛。2009年11月至2010年7月期间，来自欧洲、美洲、非洲、中东及亚太地区45个国家的33438例患者入组。在波兰，2010年2月至6月有1004例患者入组，这是东欧国家中人数最多的群体。大多数患者为男性（72.8%）。平均年龄±标准差为62.1±9.1岁。通过脉搏测定的心率为69.3±9.4次/分钟，通过心电图测定的心率为68.2±10.6次/分钟。89.9%的患者使用了β受体阻滞剂。所有患者中有49.3%静息心率≥70次/分钟，使用β受体阻滞剂的患者中有48.6%静息心率≥70次/分钟。静息心率≥70次/分钟在年轻患者、糖尿病患者、接受动脉高血压治疗的患者以及缺乏规律体育活动的患者中更为常见。静息心率≥70次/分钟的患者心绞痛症状更频繁，因心力衰竭住院的频率也更高。
尽管β受体阻滞剂使用率很高，但几乎50%的稳定型CAD患者静息心率≥70次/分钟，这与更频繁的心绞痛和缺血相关。许多CAD患者进一步降低心率是可能的。这是否会改善症状和预后正在研究中。
