Department of Pharmacy, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan 250014, China.
Department of Cardiovascular Medicine, Capital Medical University Affiliated Anzhen Hospital, Beijing 100029, China.
Int J Cardiol. 2023 Sep 15;387:131122. doi: 10.1016/j.ijcard.2023.131122. Epub 2023 Jun 15.
This study intended to investigate the independent effect of admission heart rate (HR) on the risk of major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI) patients with different left ventricular ejection fraction (LVEF) levels.
The study was a secondary analysis of the Acute Coronary Syndrome Quality Improvement in Kerela Trial. The relationship between admission HR and 30-day adverse outcomes in AMI patients with different LVEF levels was detected using a Logistic regression model. Interaction tests were used to compare the effects of different subgroups on HR and MACEs.
Our study enrolled 18,819 patients. In both partially and fully adjusted models (Model1 and Model2), the risk of MACEs was highest in patients with HR ≥ 120 (OR: 1.62, 95%CI: (1.16, 2.26), P = 0.004, Model1; OR: 1.46, 95%CI: (1.00, 2.12), P = 0.047, Model2). There was a significant interaction between LVEF and HR (P for interaction = 0.003). Meanwhile, the trend test for this association showed that HR was positively and significantly associated with the MACEs in LVEF≥40% group (OR (95%CI): 1.27 (1.12, 1.45), P < 0.001). However, in LVEF<40% group, the trend test was not statistically significant (OR (95%CI): 1.09 (0.93, 1.29), P = 0.269).
This study found that elevated admission HR was associated with a significantly higher risk for MACEs in patients admitted with AMI. Elevated admission HR was significantly associated with the risk of MACEs in AMI patients without low LVEF but not those with low LVEF (<40%). LVEF levels should be considered when evaluating the association between admission HR and the prognosis of AMI patients in the future.
本研究旨在探讨入院心率（HR）对不同左心室射血分数（LVEF）水平的急性心肌梗死（AMI）患者发生主要不良心血管事件（MACE）的独立影响。
本研究为急性冠状动脉综合征质量改善的喀拉拉邦试验的二次分析。采用 Logistic 回归模型检测不同 LVEF 水平的 AMI 患者入院 HR 与 30 天不良结局的关系。采用交互检验比较不同亚组对 HR 和 MACE 的影响。
本研究共纳入 18819 例患者。在部分和完全调整模型（模型 1 和模型 2）中，HR≥120 的患者 MACE 风险最高（OR：1.62，95%CI：（1.16，2.26），P=0.004，模型 1；OR：1.46，95%CI：（1.00，2.12），P=0.047，模型 2）。LVEF 和 HR 之间存在显著的交互作用（P 交互=0.003）。同时，该关联的趋势检验表明，HR 与 LVEF≥40%组的 MACE 显著正相关（OR（95%CI）：1.27（1.12，1.45），P<0.001）。然而，在 LVEF<40%组，趋势检验无统计学意义（OR（95%CI）：1.09（0.93，1.29），P=0.269）。
本研究发现，入院时 HR 升高与 AMI 患者发生 MACE 的风险显著增加相关。入院时 HR 与低 LVEF （<40%）的 AMI 患者的 MACE 风险无显著相关性，但与无低 LVEF 的 AMI 患者的 MACE 风险显著相关。在未来评估入院 HR 与 AMI 患者预后的关系时，应考虑 LVEF 水平。
