TY - JOUR
T1 - Importance of elevated heart rate in the very early phase of ST-segment elevation myocardial infarction
T2 - Results from the DANAMI-3 trial
AU - Nepper-Christensen, Lars
AU - Lønborg, Jacob
AU - Ahtarovski, Kiril A
AU - Høfsten, Dan E
AU - Kyhl, Kasper
AU - Schoos, Mikkel M
AU - Göransson, Christoffer
AU - Laursen, Peter N
AU - Sadjadieh, Golnaz
AU - Ghotbi, Adam Ali
AU - Bertelsen, Litten
AU - Køber, Lars
AU - Helqvist, Steffen
AU - Pedersen, Frants
AU - Jørgensen, Erik
AU - Kelbæk, Henning
AU - Vejlstrup, Niels
AU - Holmvang, Lene
AU - Engstrøm, Thomas
PY - 2019/6
Y1 - 2019/6
N2 - BACKGROUND: Elevated heart rate is associated with poor clinical outcome in patients with acute myocardial infarction. However, in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention the importance of elevated heart rate in the very early phase remains unknown. We evaluated the impact of elevated heart rate in the very early pre-hospital phase of ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention on cardiovascular magnetic resonance markers of reperfusion success and clinical outcome.METHODS: In this DANAMI-3 substudy, 1560 ST-segment elevation myocardial infarction patients in sinus rhythm without cardiogenic shock were included in the analyses of clinical outcome and 796 patients underwent cardiovascular magnetic resonance to evaluate area at risk, infarct size and left ventricular ejection fraction. Heart rate was assessed on the first electrocardiogram with ST-elevation (time of diagnosis).RESULTS: Despite equal area at risk (33%�11 versus 36%�16, p=0.174) patients with a pre-hospital heart rate ?100 beats per minute developed larger infarcts (19% (interquartile range, 9-17) versus 11% (interquartile range, 10-28), p=0.001) and a lower left ventricular ejection fraction (54%�12 versus 58%�9, p=0.047). Pre-hospital heart rate ?100 beats per minute was independently associated with an increased risk of all-cause mortality and heart failure (hazard ratio 2.39 (95% confidence interval 1.58-3.62), p<0.001).CONCLUSIONS: Very early heart rate ?100 beats per minute in ST-segment elevation myocardial infarction was independently associated with larger infarct size, reduced left ventricular ejection fraction and an increased risk of all-cause mortality and heart failure, and thus serves as an easily obtainable and powerful tool to identify ST-segment elevation myocardial infarction patients at high risk.
AB - BACKGROUND: Elevated heart rate is associated with poor clinical outcome in patients with acute myocardial infarction. However, in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention the importance of elevated heart rate in the very early phase remains unknown. We evaluated the impact of elevated heart rate in the very early pre-hospital phase of ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention on cardiovascular magnetic resonance markers of reperfusion success and clinical outcome.METHODS: In this DANAMI-3 substudy, 1560 ST-segment elevation myocardial infarction patients in sinus rhythm without cardiogenic shock were included in the analyses of clinical outcome and 796 patients underwent cardiovascular magnetic resonance to evaluate area at risk, infarct size and left ventricular ejection fraction. Heart rate was assessed on the first electrocardiogram with ST-elevation (time of diagnosis).RESULTS: Despite equal area at risk (33%�11 versus 36%�16, p=0.174) patients with a pre-hospital heart rate ?100 beats per minute developed larger infarcts (19% (interquartile range, 9-17) versus 11% (interquartile range, 10-28), p=0.001) and a lower left ventricular ejection fraction (54%�12 versus 58%�9, p=0.047). Pre-hospital heart rate ?100 beats per minute was independently associated with an increased risk of all-cause mortality and heart failure (hazard ratio 2.39 (95% confidence interval 1.58-3.62), p<0.001).CONCLUSIONS: Very early heart rate ?100 beats per minute in ST-segment elevation myocardial infarction was independently associated with larger infarct size, reduced left ventricular ejection fraction and an increased risk of all-cause mortality and heart failure, and thus serves as an easily obtainable and powerful tool to identify ST-segment elevation myocardial infarction patients at high risk.
KW - Electrocardiography
KW - Female
KW - Follow-Up Studies
KW - Heart Rate/physiology
KW - Heart Ventricles/diagnostic imaging
KW - Humans
KW - Magnetic Resonance Imaging, Cine
KW - Male
KW - Middle Aged
KW - Percutaneous Coronary Intervention/methods
KW - Prognosis
KW - ST Elevation Myocardial Infarction/diagnosis
KW - Severity of Illness Index
KW - Stroke Volume/physiology
KW - Time Factors
KW - Ventricular Function, Left/physiology
U2 - 10.1177/2048872618795515
DO - 10.1177/2048872618795515
M3 - Article
C2 - 30136597
SN - 2048-8726
VL - 8
SP - 318
EP - 328
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
IS - 4
ER -