Yao Shao-Li, Chen Xi-Wen, Liu Jie, Chen Xiao-Rong, Zhou Yao
Department of Neurology, Hospital of Chengdu Office of People's Government of Tibet Autonomous Region, Chengdu, China.
Department of Neurology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China.
Front Neurol. 2022 Oct 31;13:1017849. doi: 10.3389/fneur.2022.1017849. eCollection 2022.
The relationship of mean heart rate (MHR) with 30-day mortality in ischemic stroke patients with atrial fibrillation in the intensive care unit (ICU) remains unknown. This study aimed to investigate the association between MHR within 24 h of admission to the ICU and 30-day mortality among patients with atrial fibrillation and ischemic stroke.
This retrospective cohort study used data on US adults from the Medical Information Mart for Intensive Care-IV (MIMIC-IV, version 1.0) database. Patients with ischemic stroke who had atrial fibrillation for and first time in ICU admission were identified from the MIMIC-IV database. We used multivariable Cox regression models, a restricted cubic spline model, and a two-piecewise Cox regression model to show the effect of the MHR within 24 h of ICU admission on 30-day mortality.
A total of 1403 patients with ischemic stroke and atrial fibrillation (mean [SD] age, 75.9 [11.4] years; mean [SD] heart rate, 83.8[16.1] bpm; 743 [53.0%] females) were included. A total of 212 (15.1%) patients died within 30 days after ICU admission. When MHR was assessed in tertials according to the 25th and 50th percentiles, the risk of 30-day mortality was higher in participants in group 1 (< 72 bpm; adjusted hazard ratio, 1.23; 95% CI, 0.79-1.91) and group 3 (≥82 bpm; adjusted hazard ratio, 1.77; 95% CI, 1.23-2.57) compared with those in group 2 (72-82 bpm). Consistently in the threshold analysis, for every 1-bpm increase in MHR, there was a 2.4% increase in 30-day mortality (adjusted HR, 1.024; 95% CI, 1.01-1.039) in those with MHR above 80 bpm. Based on these results, there was a J-shaped association between MHR and 30-day mortality in ischemic stroke patients with atrial fibrillation admitted to the ICU, with an inflection point at 80 bpm of MHR.
In this retrospective cohort study, MHR within 24 h of admission was associated with 30-day mortality (nonlinear, J-shaped association) in patients with ischemic stroke and atrial fibrillation in the ICU, with an inflection point at about 80 bpm and a minimal risk observed at 72 to 81 bpm of MHR. This association was worthy of further investigation. If further confirmed, this association may provide a theoretical basis for formulating the target strategy of heart rate therapy for these patients.
重症监护病房（ICU）中缺血性卒中合并心房颤动患者的平均心率（MHR）与30天死亡率之间的关系尚不清楚。本研究旨在探讨入住ICU 24小时内的MHR与心房颤动合并缺血性卒中患者30天死亡率之间的关联。
这项回顾性队列研究使用了来自重症监护医学信息数据库-IV（MIMIC-IV，版本1.0）中美国成年人的数据。从MIMIC-IV数据库中识别出在ICU入院时首次发生心房颤动的缺血性卒中患者。我们使用多变量Cox回归模型、受限立方样条模型和两段式Cox回归模型来显示入住ICU 24小时内的MHR对30天死亡率的影响。
共纳入1403例缺血性卒中和心房颤动患者（平均[标准差]年龄，75.9[11.4]岁；平均[标准差]心率，83.8[16.1]次/分钟；743例[53.0%]为女性）。共有212例（15.1%）患者在ICU入院后30天内死亡。当根据第25和第50百分位数将MHR分为三分位数进行评估时，第1组（<72次/分钟；调整后风险比，1.23；95%可信区间，0.79-1.91）和第3组（≥82次/分钟；调整后风险比，1.77；95%可信区间，1.23-2.57）的参与者30天死亡风险高于第2组（72-82次/分钟）。在阈值分析中，一致的是，对于MHR高于80次/分钟的患者，MHR每增加1次/分钟，30天死亡率增加2.4%（调整后风险比，1.024；95%可信区间，1.01-1.039）。基于这些结果，入住ICU的缺血性卒中合并心房颤动患者的MHR与30天死亡率之间存在J形关联，拐点为MHR 80次/分钟。
在这项回顾性队列研究中，入住ICU 24小时内的MHR与ICU中缺血性卒中和心房颤动患者的30天死亡率相关（非线性，J形关联），拐点约为80次/分钟，MHR在72至81次/分钟时观察到最低风险。这种关联值得进一步研究。如果得到进一步证实，这种关联可能为制定这些患者的心率治疗目标策略提供理论依据。
