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Admission Heart Rate Predicts Mortality Following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: An Observational Study

Lookup NU author(s): Dr Karthik Balasubramaniam, Dr Rajiv Das, Dr Vijay Kunadian, Professor Azfar Zaman

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Abstract

BackgroundThe prognostic value of admission heart rate (HR) on long-term mortality in ST-elevation myocardial infarction (STEMI) remains uncertain in the modern era of primary percutaneous coronary intervention (PPCI). This study aimed to assess the predictive value of admission HR on long-term mortality following PPCI and the influence of beta-blockers on postdischarge survival.MethodsRetrospective analysis of prospectively collected data on 2310 PPCI-treated STEMI patients at a regional tertiary center between March 2008 and June 2010.ResultsPatients were classified according to admission HR into either low (70beat per minute [bpm], n=1015) or high HR group (>70bpm, n=1295). At a median follow-up of 559days, all-cause mortality was 7.0% in the low HR group compared to 12.7% in the high-HR group. In the Cox proportional hazard model, adjusted for several confounders, the hazard ratio (95% confidence interval) for all-cause mortality in the high HR group was 1.59 (1.15-2.20; P=0.005). Every 10-bpm increase in admission HR was associated with 17% increase in all-cause mortality. Beta-blockers on discharge was associated with a reduction in postdischarge mortality only in the high HR group (adjusted hazard ratio, 0.49 [0.31-0.77; P=0.002]), but not in the low HR group (adjusted hazard ratio, 0.74 [0.37-1.49; P=0.33]).ConclusionsElevated admission heart rate in PPCI-treated STEMI patients is associated with long-term all-cause mortality. Beta blocker therapy improved postdischarge survival in patients with elevated admission heart rate.


Publication metadata

Author(s): Zaman AG; Das R; Kunadian V; Balasubramaniam K; Noman A; Ang D; Ivanauskiene T

Publication type: Article

Publication status: Published

Journal: Cardiovascular Therapeutics

Year: 2013

Volume: 31

Issue: 6

Pages: 363-369

Print publication date: 01/12/2013

Online publication date: 27/11/2013

ISSN (print): 1755-5914

ISSN (electronic): 1755-5922

Publisher: WILEY-BLACKWELL

URL: http://dx.doi.org/10.1111/1755-5922.12031

DOI: 10.1111/1755-5922.12031


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