Yuksek Umit, Cerit Levent, Yaman Belma, Kemal Hatice, Etikan İlker, Akpınar Onur, Duygu Hamza
Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Turkish Republic of Northern Cyprus.
Department of Biostatistics, Near East University Faculty of Medicine, Nicosia, Turkish Republic of Northern Cyprus.
Acta Cardiol. 2023 Feb;78(1):17-23. doi: 10.1080/00015385.2021.1979785. Epub 2021 Sep 27.
In acute coronary syndrome (ACS) patients there are mostly studies evaluating prognostic value of admission heart rate. We tried to understand the prognostic value of discharge heart rate in a spectrum of ACS patients.
A total of 473 consecutive ACS patients were included in the study. Forty-three (9.1%) of them were unstable angina pectoris, 268 (56.7%) were non-ST elevation myocardial infarction and 162 (34.2%) of them were ST elevation myocardial infarction patients. Discharge heart rates of the patients were recorded and the patients were followed-up for 1 year. The primary end-point was all-cause mortality.
The mean age of the patients was 64 ± 12. The patients were divided into three subgroups according to discharge heart rates (<78, 78-89, ≥90 beats per minute). Patients with a higher discharge heart rate had higher serum troponin, glucose levels and higher admission heart rates, had lower ejection fraction values and had acute heart failure complication more frequently than the patients with a lower discharge heart rate. A total of 72(16%) patients died during 1 year follow-up. In multivariate logistic regression analysis, an increased discharge heart rate was independently associated with 1-month mortality after ACS, but it was not independently associated with 6-month or 1-year mortality after ACS. Every 1 bpm increase in discharge heart rate resulted in a significant increased risk of 8.2% in 1-month all-cause mortality.
Increased heart rate at discharge is an independent predictor of 1-month mortality in ACS patients. This relationship disappears after 1-month through 1-year follow-up.
在急性冠状动脉综合征（ACS）患者中，大多数研究评估的是入院时心率的预后价值。我们试图了解出院时心率在一系列ACS患者中的预后价值。
本研究共纳入473例连续的ACS患者。其中43例（9.1%）为不稳定型心绞痛，268例（56.7%）为非ST段抬高型心肌梗死，162例（34.2%）为ST段抬高型心肌梗死患者。记录患者的出院心率，并对患者进行1年的随访。主要终点是全因死亡率。
患者的平均年龄为64±12岁。根据出院心率（<78、78 - 89、≥90次/分钟）将患者分为三个亚组。出院心率较高的患者血清肌钙蛋白、血糖水平较高，入院心率较高，射血分数值较低，急性心力衰竭并发症的发生率比出院心率较低的患者更高。在1年的随访期间，共有72例（16%）患者死亡。在多因素逻辑回归分析中，出院心率升高与ACS后1个月死亡率独立相关，但与ACS后6个月或1年死亡率无独立相关性。出院心率每增加1次/分钟，1个月全因死亡率的风险显著增加8.2%。
出院时心率升高是ACS患者1个月死亡率的独立预测因素。在1个月至1年的随访后，这种关系消失。
