Wu Dan, Yin Yanping, Zheng Jing, Zhou Xiaoshan, Cheng Fanli, Wang Yiran, Li Kaini, Mou Xuanting, Lin Wenting, Feng Chao, Jia Sixiang, Ge Weili, Xia Shudong
Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China.
Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
Ann Med. 2025 Dec;57(1):2468267. doi: 10.1080/07853890.2025.2468267. Epub 2025 Feb 22.
Timely percutaneous coronary intervention (PCI) is crucial for restoring myocardial blood supply in ST-segment elevation myocardial infarction (STEMI) patients, with the first 72 h being a critical period for early ventricular remodelling. The association between heart rate trajectories within this period and after hospital discharge outcomes in STEMI patients post-PCI remains unclear.
We conducted a retrospective study involving STEMI patients who underwent successful PCI at three tertiary hospitals in Zhejiang Province, China. Heart rate data were collected every 8 h post-PCI through nursing records, along with intraoperative findings and biochemical markers. Using trajectory modelling, we identified heart rate patterns at 24, 48 and 72 h post-PCI, determined the optimal number of trajectory groups using Akaike information criterion (AIC) and Bayesian information criterion (BIC) criteria, and performed a minimum 3-month follow-up. Cox regression analysed the association between early heart rate trajectories and major adverse cardiovascular events (MACEs) post-discharge. The prognostic value of trajectory models was assessed using the area under the curve (AUC).
A total of 1257 patients were included, with an average follow-up duration of 28.72 ± 21.14 months and a mean age of 60.42 ± 14.19 years; 1013 (80.59%) were male. Growth mixture modelling identified four distinct heart rate trajectory groups at 24, 48 and 72 h post-PCI. Higher heart rate trajectories with rates greater than 80 bpm were strongly associated with MACEs, and the 72-hour heart rate trajectory showed a predictive value for MACEs (AUC = 0.745, 95% CI: 0.709-0.781).
Elevated heart rate trajectories exceeding 80 bpm within 72 h after PCI are associated with an increased risk of MACEs post-discharge. Heart rate management should be further emphasized in post-PCI STEMI patients.
及时进行经皮冠状动脉介入治疗（PCI）对于恢复ST段抬高型心肌梗死（STEMI）患者的心肌血供至关重要，最初72小时是早期心室重构的关键时期。STEMI患者PCI术后这一时期内心率轨迹与出院后结局之间的关联尚不清楚。
我们进行了一项回顾性研究，纳入了在中国浙江省三家三级医院接受成功PCI的STEMI患者。通过护理记录收集PCI术后每8小时的心率数据，以及术中发现和生化标志物。使用轨迹模型，我们确定了PCI术后24、48和72小时的心率模式，使用赤池信息准则（AIC）和贝叶斯信息准则（BIC）标准确定轨迹组的最佳数量，并进行了至少3个月的随访。Cox回归分析了早期心率轨迹与出院后主要不良心血管事件（MACE）之间的关联。使用曲线下面积（AUC）评估轨迹模型的预后价值。
共纳入1257例患者，平均随访时间为28.72±21.14个月，平均年龄为60.42±14.19岁；1013例（80.59%）为男性。生长混合模型确定了PCI术后24、48和72小时有四个不同的心率轨迹组。心率大于80次/分钟的较高心率轨迹与MACE密切相关，72小时心率轨迹对MACE具有预测价值（AUC = 0.745，95%CI：0.709 - 0.781）。
PCI术后72小时内心率轨迹超过80次/分钟与出院后MACE风险增加相关。PCI术后STEMI患者应进一步强调心率管理。
