Department of Cardiology, Alfred Hospital, Victoria, Australia.
Department of Cardiology, the Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Am J Cardiol. 2018 Oct 1;122(7):1113-1120. doi: 10.1016/j.amjcard.2018.06.042. Epub 2018 Jul 4.
Data from previous studies of patients with heart failure and coronary artery disease suggest that those with higher resting heart rates (HRs) have worse cardiovascular outcomes. We sought to evaluate whether HR immediately before percutaneous coronary intervention (PCI) is an independent predictor for 30-day outcome. We analyzed the outcome of 3,720 patients who had HR recorded before PCI from the Melbourne Interventional Group registry. HR and outcomes were analyzed by quintiles, and secondarily by dichotomizing into <70 or ≥70 beats/min. Patients with cardiogenic shock, intra-aortic balloon pump or inotropic support, and out-of-hospital arrest were excluded. The mean ± SD HR was 70.9 ± 14.7 beats/min. HR by quintile was 55 ± 5, 64 ± 2, 70 ± 1, 77 ± 3, and 93 ± 13 beats/min, respectively. Patients with higher HR were more likely to be women, current smokers, have higher systolic and diastolic blood pressure, atrial fibrillation, recent heart failure, lower ejection fraction, and ST-elevation myocardial infarction as the indication for the PCI (all p ≤0.002). However, rates of treated hypertension, multivessel disease, previous myocardial infarction, PCI, and coronary bypass surgery were lower (all p ≤0.004). Increased HR was associated with higher 30-day mortality (p for trend = 0.04), target vessel revascularization (p for trend = 0.003), and 30-day major adverse cardiac events (MACE) (p for trend = 0.004). In a multivariable analysis, HR was an independent predictor of 30-day MACE (OR 1.21 per quintile; 95% confidence interval (CI): 1.06 to 1.39, p = 0.004). When dichotomized into <70 or ≥70 beats/min, HR independently predicted both 30-day MACE (OR 1.59, 95% CI 1.08 to 2.36, p = 0.02) and 30-day mortality (OR 2.80, 95% CI 1.10 to 7.08, p = 0.03). In conclusion, HR immediately before PCI is an independent predictor of adverse 30-day cardiovascular outcomes.
先前针对心力衰竭和冠状动脉疾病患者的研究数据表明，静息心率较高的患者心血管结局较差。我们旨在评估经皮冠状动脉介入治疗（PCI）前的即时心率是否是 30 天结局的独立预测因素。我们分析了墨尔本介入组注册中心记录有 PCI 前心率的 3720 例患者的结局。通过五分位数分析心率和结局，并将其进一步分为<70 或≥70 次/分。排除心源性休克、主动脉内球囊泵或正性肌力支持以及院外心脏骤停的患者。平均心率±标准差为 70.9±14.7 次/分。五分位组的心率分别为 55±5、64±2、70±1、77±3 和 93±13 次/分。心率较高的患者更可能为女性、当前吸烟者，血压更高（收缩压和舒张压）、心房颤动、近期心力衰竭、射血分数更低，并且 ST 段抬高型心肌梗死为 PCI 指征（所有 p≤0.002）。然而，高血压治疗率、多支血管病变、既往心肌梗死、PCI 和冠状动脉旁路移植术的比率较低（所有 p≤0.004）。心率升高与 30 天死亡率升高（趋势 p=0.04）、靶血管血运重建（趋势 p=0.003）和 30 天主要不良心脏事件（MACE）（趋势 p=0.004）相关。在多变量分析中，心率是 30 天 MACE 的独立预测因素（每五分位增加 1.21；95%置信区间：1.06 至 1.39，p=0.004）。当分为<70 或≥70 次/分时，心率独立预测 30 天 MACE（OR 1.59，95%CI 1.08 至 2.36，p=0.02）和 30 天死亡率（OR 2.80，95%CI 1.10 至 7.08，p=0.03）。总之，PCI 前的心率是不良 30 天心血管结局的独立预测因素。
