Lin Ching-Heng, Zhang Jun-Fu, Kuo Ya-Wen, Kuo Chang-Fu, Huang Yen-Chu, Lee Meng, Lee Jiann-Der
Center for Artificial Intelligence in Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan.
BMC Neurol. 2024 Jul 31;24(1):267. doi: 10.1186/s12883-024-03772-3.
Although elevated heart rate is a risk factor for cardiovascular morbidity and mortality in healthy people, the association between resting heart rate and major cardiovascular risk in patients after acute ischemic stroke remains debated. This study evaluated the association between heart rate and major adverse cardiovascular events after ischemic stroke.
We conducted a retrospective cohort study analyzing data from the Chang Gung Research Database for 21,655 patients with recent ischemic stroke enrolled between January 1, 2010, and September 30, 2018. Initial in-hospital heart rates were averaged and categorized into 10-beats per minute (bpm) increments. The primary outcome was the composite of hospitalization for recurrent ischemic stroke, myocardial infarction, or all-cause mortality. Secondary outcomes were hospitalization for recurrent ischemic stroke, myocardial infarction, and heart failure. Hazard ratios and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, using the heart rate < 60 bpm subgroup as the reference.
After a median follow-up of 3.2 years, the adjusted hazard ratios for the primary outcome were 1.13 (95% CI: 1.01 to 1.26) for heart rate 60-69 bpm, 1.35 (95% CI: 1.22 to 1.50) for heart rate 70-79 bpm, 1.64 (95% CI: 1.47 to 1.83) for heart rate 80-89 bpm, and 2.08 (95% CI: 1.85 to 2.34) for heart rate ≥ 90 bpm compared with the reference group. Heart rate ≥ 70 bpm was associated with increased risk of all secondary outcomes compared with the reference group except heart failure. CONCLUSIONS: Heart rate is a simple measurement with important prognostic implications. In patients with ischemic stroke, initial in-hospital heart rate was associated with major adverse cardiovascular events.
虽然心率升高是健康人心血管发病和死亡的危险因素，但急性缺血性中风患者静息心率与主要心血管风险之间的关联仍存在争议。本研究评估了心率与缺血性中风后主要不良心血管事件之间的关联。
我们进行了一项回顾性队列研究，分析了2010年1月1日至2018年9月30日期间纳入长庚研究数据库的21655例近期缺血性中风患者的数据。将入院初期的心率进行平均，并按每分钟10次心跳（bpm）的增量进行分类。主要结局是复发性缺血性中风、心肌梗死或全因死亡的住院综合情况。次要结局是复发性缺血性中风、心肌梗死和心力衰竭的住院情况。使用Cox比例风险模型估计风险比和95%置信区间（CI），以心率<60 bpm亚组作为参考。
在中位随访3.2年后，与参考组相比，主要结局的调整后风险比在心率60 - 69 bpm时为1.13（95% CI：1.01至1.26），心率70 - 79 bpm时为1.35（95% CI：1.22至1.50），心率80 - 89 bpm时为1.64（95% CI：1.47至1.83），心率≥90 bpm时为2.08（95% CI：1.85至2.34）。与参考组相比，心率≥70 bpm与除心力衰竭外的所有次要结局风险增加相关。
心率是一项具有重要预后意义的简单测量指标。在缺血性中风患者中，入院初期的心率与主要不良心血管事件相关。
