Discharge heart rate and mortality after acute myocardial infarction.
Am J Med. 2014 Jul 5;
Authors: Seronde MF, Geha R, Puymirat E, Chaib A, Simon T, Berard L, Drouet E, Bataille V, Danchin N, Schiele F
BACKGROUND: We aimed to describe the determinants of discharge heart ratein acute coronary syndrome patients and assess the impact of discharge heart rateon 5 year mortality in hospital survivors.
METHODS: FAST-MI (French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction) 2005 is a nationwide French registry that included all consecutive patients with acute myocardial infarction over 1 month in 223 institutions in 2005. Discharge heart rate was recorded in 3079 pts discharged alive; all had 5-year follow-up. Logistic regression was used to detect predictors of high heart rate at discharge. Cox's proportional hazards model was used to assess the Hazard Ratiofor mortality at 5 years. Heart rate was categorized into 4 groups by quartiles (<60, 61-67, 68-75, >75).High heart rate was defined as ≥75bpm. Landmark analysis was performed at 1 year.
RESULTS: Independent predictors of heart rate≥75bpm at discharge were female sex, ST-segment elevation myocardial infarction (STEMI), diabetes, chronic obstructive pulmonary disease, bleeding/transfusion during hospitalization, left ventricular dysfunction, renal dysfunction, prescription (type, but not dose category) of beta-blockers at discharge. Discharge heart rate was significantly related to mortality at 1 year (hazard ratio=1.13 [1.03; 1.24] per 10 bpm, p=0.02); this was confirmed by landmark analysis, with a 39% increase (hazard ratio =1.39 [1.05; 1.84]) in the risk of 1-year death for discharge heart rate ≥75bpm versus <75bpm. This relationship was no longer significant between 2 and 5 years.
CONCLUSIONS: After acute myocardial infarction, pts discharged with high heart rate (≥ 75 bpm) are at higher risk of death during the first year, but not later, irrespective of beta-blocker use.
PMID: 25004457 [PubMed - as supplied by publisher]