Relationship Between Nocturnal Heart Rate Pattern And Long-term Prognosis Of STEMI Patients After PCI

Objectives:Objective to explore the relationship between nocturnal heart rate pattern and long-term prognosis in patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Materials and methods:1.A total of 1461 STEMI patients who underwent PCI in the cardiovascular diagnosis and treatment center of the first hospital of Jilin University from May 2017 to may 2018 were collected.According to the inclusion and exclusion criteria,a total of 1166 patients were included.2.Collect the general clinical data and heart rate of the patients in the cardiac intensive care unit(CCU),and rec-ord the sleep and awake time of the patients.According to the heart rate pattern,they were divided into three groups,group A was dipper heart rate group(100 cases)(awake heart rate-sleep heart rate / awake heart rate ≥ 10%),group B was non-dipper heart rate group(821 cases)(awake heart rate-sleep heart rate / awake heart rate < 10%),group C was reverse dipper heart rate group(245 cases)(awake heart rate-sleep heart rate / awake heart rate < 0).1166 patients were followed up by telephone,with a median of 33 months.The above awake and sleeping heart rate refers to the average heart rate of each time period.3.The baseline data of heart rate pattern,incidence of adverse.cardiovascular events(MACE)and all-cause death were compared among the three groups,and Kaplan-Meier survival analysis was performed,Cox analysis was used to screen out the related factors of MACE and all-cause death,and the multivariate Cox regression analysis was used to explore the influence of nocturnal heart rate pattern,sleep average heart rate,awake average heart rate and 24-hour average heart rate on prognosis,and to compare their predictive valueresult:1.Compared with group A and group B,the age of group C was higher(P < 0.05).The sleep average heart rate of group A、group B and group C increased in turn,and the difference was statistically significant(P < 0.05).The awake average heart rate of group B was the lowest,and the difference was statistically significant compared with group C(P < 0.05).The 24-hour average heart rate of group C was the highest,which was significantly different from that of group A(P < 0.05).2.During the follow-up period,a total of 182 cases of MACE events occurred.The incidence of MACE in group A,B and C increased in turn(4.5%,15.4%,26%),with statistical difference.The incidence of recurrent angina pectoris and recurrent non-fatal myocardial infarction in group A was significantly lower than that in group B and group C,with statistical difference(P < 0.05).There was no statistical difference between group B and group C.3.During the follow-up period,55 cases of all-cause death occurred,including 27 cases of cardiac death.The incidence of all-cause death in group A,B and C increased in turn(1.3%,4.8%,7.7%).There was a significant difference between group A and group C(P < 0.005).4.Kaplan-Meier survival curve analysis showed that in MACE events,the cumulative survival rates of group A,group B and group C decreased in turn,with statistical difference between two groups(P <0.05).The survival rate of all-cause death in group A was significantly higher than that in group B and group C(P < 0.05).There was no significant difference between group B and group C(P > 0.05)5.In multivariate Cox regression analysis,after adjusting for age,gender and traditional cardiovascular risk factors,the average sleep heart rate increased(HR = 1.022,95% CI = 1.011-1.034,P < 0.001),non-dipper(HR = 3.198,95% CI = 1.49-6.867,P = 0.003),and reverse dipper(HR = 4.663,95% CI = 2.068-10.518),Heart rate was associated with increased risk of MACE,while only increased sleep heart rate was associated with increased risk of all-cause death(HR = 1.057,95% CI = 1.038-1.077),When the number of diseased vessels,Killip grade at admission,cardiac function related factors and medication factors were included,only non-dipper and reverse dipper heart rate patterns were associated with the increased risk of MACE,while the increased risk of all-cause death was always only associated with the increased average sleep heart rate.In multivariate analysis,awake average heart rate and 24-hour average heart rate were not associated with MACE and all-cause death.Conclusion1.In the sample,patients of dipper type、non-dipper type and reverse dipper type accounted for 13.2%,71.3% and 15.5% of the total sample size,respectively.The rate of nocturnal heart rate decline was negatively correlated with age.2.When the risk factors were not adjusted,the 24-hour average heart rate,awake average heart rate,sleep average heart rate and night heart rate pattern were related to the prognosis.After adjusting for different risk factors,the increase of sleep average heart rate and the non-dipper and reverse dipper groups in nocturnal heart rate pattern were independent risk factors for MACE,and the increase of sleep average heart rate was independent risk factor for all-cause death3.In multivariate analysis,24-hour average heart rate and awake heart rate had no correlation with prognosis,suggesting that sleep average heart rate and nighttime heart rate pattern may be more valuable predictors.