IMPACT OF HEART RATE AT DISCHARGE AS A PROGNOSIS FACTOR IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI)

Abstract

Historically, an increased resting heart rate (HR) in patients with coronary artery disease has been reported to be associated with a prognosis factor. However, it is unclear if an increased HR at discharge is associated with the prognosis of ST elevated myocardial infarction (STEMI) in the coronary intervention era. We enrolled 386 consecutive patients with STEMI within 24 hr of symptom onset between June 2001 and February 2013. They were divided into groups with a heart rate of 70 bpm or greater (173 patients) versus less than 70 bpm (213 patients). We assessed the rates of major adverse cardiac and cerebrovascular event (MACCE*) between two groups. In addition to the overall analysis we also performed the same analyses separately for patients with LAD, RCA, and LCX lesion. The HR＞70 group had a significantly higher incidence of MACCE than the HR＜70 group (p＝0.002). Although there was a significant difference between the two groups in LAD (p＝0.017), there were no differences in RCA and LCX (p＝0.150, 0.923). Although multivariate analysis demonstrated that HR＜70 was one of independent predictors of MACCE in LAD lesion, HR＜70 was not an independent predictor of MACCE in all patients. The present study suggested that in patients with STEMI, elevated heart rate at discharge could be an independent prognosis factor, especially in patients with LAD lesion.