Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway.
Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway.
Int J Cardiol. 2017 Dec 15;249:274-281. doi: 10.1016/j.ijcard.2017.09.182. Epub 2017 Sep 24.
Heart rate has been reported to be associated with adverse outcome in heart failure (HF) and myocardial infarction (MI), but conflicting evidence exists regarding its impact in patients with associated atrial fibrillation (AF).
We investigated the differential impact of heart rate on clinical outcomes according to the presence or absence of AF in patients with reduced systolic function and/or HF after MI.
We studied the association of heart rate with outcome using Cox-models in a merged dataset (n=28,771) of four randomized trials (CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT).
At baseline, 3736 (13%) patients had AF. We identified a significant interaction between AF and heart rate, and a decreasing effect of heart rate with time, heart rate being less associated with outcome after 1year of follow-up (both p for interaction <0.001). We report associations with outcome separately in patients with and without AF. In addition, as neutral associations with outcome after 1year were estimated after adjustment on confounding factors, only association for the first year follow-up were provided. 10-bpm increase in heart rate conferred increased risk for all-cause mortality (1.27 [1.21 to 1.33], p<0.0001), CV-mortality (1.28 [1.22 to 1.34], p<0.0001), and HF-hospitalisation (1.25 [1.19 to 1.31], p<0.0001) in patients without AF. In contrast, in patients with AF, the incremental risk for 10-bpm increase in heart rate was attenuated for all-cause (1.14 [1.06 to 1.23], p=0.0007), CV-mortality (1.12 [1.03 to 1.22], p=0.006), and HF-hospitalisation (1.16 [1.07 to 1.26], p=0.0006, p for interaction with AF <0.001 for all outcomes).
In patients with reduced systolic function and/or HF post-MI, higher heart rate predicts increased major cardiovascular events during the first year following MI in patients without AF. This association is markedly attenuated in subjects with AF.
心率已被报道与心力衰竭（HF）和心肌梗死（MI）的不良结局相关，但关于其在合并心房颤动（AF）的患者中的影响仍存在相互矛盾的证据。
我们研究了在 MI 后收缩功能降低和/或 HF 的患者中，根据是否存在 AF，心率对临床结局的不同影响。
我们使用 Cox 模型在四项随机试验（CAPRICORN、EPHESUS、OPTIMAL 和 VALIANT）的合并数据集（n=28771）中研究了心率与结局的关联。
基线时，3736（13%）例患者有 AF。我们发现 AF 和心率之间存在显著的交互作用，并且随着时间的推移，心率的影响逐渐降低，在随访 1 年后，心率与结局的相关性降低（两者的交互作用 p 值均<0.001）。我们分别在有和没有 AF 的患者中报告了与结局的关联。此外，由于在调整混杂因素后估计 1 年后与结局呈中性关联，因此仅提供了第一年随访的关联。心率每增加 10 次/分钟，全因死亡率（1.27[1.21 至 1.33]，p<0.0001）、心血管死亡率（1.28[1.22 至 1.34]，p<0.0001）和 HF 住院率（1.25[1.19 至 1.31]，p<0.0001）的风险均增加。相比之下，在有 AF 的患者中，心率每增加 10 次/分钟，全因（1.14[1.06 至 1.23]，p=0.0007）、心血管死亡率（1.12[1.03 至 1.22]，p=0.006）和 HF 住院率（1.16[1.07 至 1.26]，p=0.0006）的风险增加幅度减弱，与 AF 的交互作用 p 值<0.001）。
在 MI 后收缩功能降低和/或 HF 的患者中，无 AF 的患者中，较高的心率预示着 MI 后第一年主要心血管事件的增加。在有 AF 的患者中，这种相关性明显减弱。
