The Relationship Between Different Admission Heart Rate And Outcomes Of Non-ST-elevation Myocardial Infarction

[Objective]The relationship between heart rate and cardiovascular outcomes is well recognized and has been studied in stable angina pectoris(SAP),acute non-ST-elevation acute coronary syndrome(NSTE-ACS)and ST segment elevation myocardial infarction(STEMI)patients.NSTE-ACS includes unstable angina(UA)and acute non-ST-segment elevation myocardial infarction(NSTEMI).Patients with NSTEMI were more serious with many characteristics,including patients with many risk factors and multivessel coronary artery disease,higher recurrent myocardial infarction risk and poor long-term prognosis.There are few researches about heart rate and outcome of NSTEMI.This trial is intended to explore the relationship between admission heart rate and outcome of non-ST-segment elevation myocardial infarction patients.[Methods]We collect patients with NSTEMI from First Affiliated Hospital of DaLian Medical University between January 2003 and December 2015 and follow-up of 1 year.The primary outcome was all-cause death;the secondary outcome were the composite of all-cause death,recurrent myocardial infarction,recurrent angina and heart failure.The patients were divided into 4groups by admission heart rate:<60BPM,60-74BPM,75-90BPM,>90BPM.Analyzing the follow-up composite of endpoints,compare the outcomes of different admission heart rate in patients with non-ST-segment elevation myocardial infarction.[Results]:A total of 2323 cases of acute non-ST-segment elevation infarction were enrolled in this study.They were divided into 4 groups:<60BPM(220 cases)?60?74BPM(989 cases)?75?90BPM(154 cases)?>90BPM(34cases)?History of coronary heart disease,hypertension,diabetes,stroke,Killip level ?-?,creatinine,fasting blood-glucose level,systolic blood pressure levels and proportion of LVEF<40%higher than other groups(P<0.05).Univariate analysis showed that the mortality rate was 5.5%in HR<60BPM group and was 4.2%in HR 60?74BPM group(P<0.001),and the mortality of groups of HR?60BPM increased with the elevating of heart rate(all P<0.001,4.2%in60?74BPM group,7.8%in 75 ?90BPM group,14.4%in?90BPM group);the incidence of composite event was 10.0%in HR<60BPM group and was 8.4%in HR 60?74BPM group(P<0.001),and incidence of composite event groups of HR>60BPM increased with the elevating of heart rate(all P<0.001,8.4%in60?74BPM group,15.1%in 75?90BPM group,22.9%in>90BPM group).Multivariate analysis showed that the incidence of mortality positively correlate with admission HR except<60BPM group(HR 75?89BPM group:OR=1.892,95%CI 1.264-2.831,P=0.002;HR?90BPM group:OR=3.653,95%CI2.482-5.398,P<0.001);the incidence of composite event positively correlate with admission HR except<60BPM group(HR 75?89BPM group:OR=1.811,95%CI 1.356-2.418,P<0.001;HR?90BPM group:OR=2.628,95%CI 1.963-3.519,P<0.001).In patients with age 75 or higher,only when mortality and incidence of composite events the heart rate?90 BPM significantly increased significantly(P<0.01).Subgroup analysis showed that admission heart rate of patients with conservative treatment still was the independent risk factor for mortality and the composite events[respectively:(OR = 1.340,95%CI 1.097 1.636,P = 0.004),(OR =1.247,95%CI 1.067 1.458,P = 0.006)],while relationship between heart rate of patients treated by reascularization and mortality and the composite events was no longer significant(P>0.05).[Conclusion]1.Admission heart rate in patients with acute non-ST segment elevation myocardial infarction is an independent risk factor for mortality and composite events.2.When admission heart rate?60BPM,mortality and incidence of composite events increase with the elevating of admission heart rate.In patients with age 75 or higher,only when mortality and incidence of composite events the heart rate?90 BPM significantly increased.3.Conservative treatment can improve the effect of heart rate on prognosis of NSTEMI patients.