Jichi Medical University School of Medicine.
Precision Inc.
Circ J. 2023 Jan 25;87(2):336-344. doi: 10.1253/circj.CJ-22-0314. Epub 2022 Oct 7.
The optimal heart rate (HR) and optimal dose of β-blockers (BBs) in patients with coronary artery disease (CAD) have been unclear. We sought to clarify the relationships among HR, BB dose, and prognosis in patients with CAD using a multimodal data acquisition system.
We evaluated the data for 8,744 CAD patients who underwent cardiac catheterization from 6 university hospitals and the National Cerebral and Cardiovascular Center and who were registered using the Clinical Deep Data Accumulation System. Patients were divided into quartile groups based on their HR at discharge: Q1 (HR <60 beats/min), Q2 (HR 60-66 beats/min), Q3 (HR 67-74 beats/min), and Q4 (HR ≥75 beats/min). Among patients with acute coronary syndrome (ACS) and patients with chronic coronary syndrome (CCS), those in Q4 (HR ≥75 beats/min) had a significantly greater incidence of major adverse cardiac and cerebral events (MACCE) compared with those in Q1 (ACS patients: hazard ratio 1.65, P=0.001; CCS patients: hazard ratio 1.45, P=0.019). Regarding the use of BBs (n=4,964), low-dose administration was significantly associated with MACCE in the ACS group (hazard ratio 1.41, P=0.012), but not in patients with CCS after adjustment for covariates.
HR ≥75 beats/min was associated with worse outcomes in patients with CCS or ACS.
冠心病患者的最佳心率（HR）和β受体阻滞剂（BB）剂量仍不明确。我们使用多模态数据采集系统，旨在明确 HR、BB 剂量与冠心病患者预后之间的关系。
我们评估了来自 6 所大学医院和国家心肺血管中心的 8744 例接受心脏导管检查并使用临床深度数据采集系统登记的冠心病患者的数据。根据出院时的 HR 将患者分为四分位组：Q1（HR＜60 次/分）、Q2（HR 60-66 次/分）、Q3（HR 67-74 次/分）和 Q4（HR≥75 次/分）。在急性冠脉综合征（ACS）和慢性冠脉综合征（CCS）患者中，Q4（HR≥75 次/分）组发生主要不良心脑血管事件（MACCE）的发生率明显高于 Q1 组（ACS 患者：风险比 1.65，P=0.001；CCS 患者：风险比 1.45，P=0.019）。关于 BB 的使用（n=4964），在调整协变量后，低剂量 BB 与 ACS 组的 MACCE 显著相关（风险比 1.41，P=0.012），但在 CCS 患者中不相关。
HR≥75 次/分与 ACS 或 CCS 患者的预后不良相关。
