Abstract
IntroductionAssociation of heart rate (HR) with mortality in patients with acute coronary syndrome (ACS) and aged ≥ 80 years are underrepresented in clinical trials. We therefore aimed to investigate the association of HR in atrial fibrillation (AF) versus sinus rhythm (SR) with all-cause mortality in octogenarian patients with ACS.MethodsA total of 336 patients with ACS patients and aged ≥ 80 years were enrolled into the current study. The end point of interest was death from any cause. Association of HR in AF versus SR with mortality was analyzed by Kaplan-Meier curve following log-rank test and multivariable Cox regression analysis.ResultsIn total, 63 (87.5%) of patients with AF were dead and 147 (59.8%) of patients with SR were dead during the follow-up period. The best cut-off was 80 bpm, with a sensitivity of 62% and specificity of 66%. HR ≤ 80 bpm in SR but not in AF was associated with better outcome as compared with HR > 80 bpm (Chi-Square = 26.55, Log rank P < 0.001). In SR subgroup, the hazard ratios of HR ≤ 80 bpm were 0.51(95% CI 0.37-0.70, P < 0.001) adjusted for age, 0.46 (95%CI 0.33-0.63, P < 0.001) adjusted for gender, 0.62 (95%CI 0.42- 0.93, P = 0.020) adjusted for multivariables respectively. In AF subgroup, the hazard ratios of HR ≤ 80 bpm were 0.83(95% CI 0.49-1.38, P = 0.464) adjusted for age, 0.96 (95%CI 0.59-1.58, P = 0.882) adjusted for gender, 0.72(95% CI 0.41-1.26, P = 0.249) adjusted for multivariables respectively.ConclusionThe current study demonstrates that heart rate is an independent prognostic predictor for all-cause mortality, and HR ≤ 80 bpm is associated with improved outcome in SR but not in AF in octogenarian patients with ACS.
Highlights
Association of heart rate (HR) with mortality in patients with acute coronary syndrome (ACS) and aged ≥ 80 years are underrepresented in clinical trials
The current study reported the association of HR in atrial fibrillation (AF) versus sinus rhythm (SR) with mortality in octogenarian patients with ACS
The principal findings are that admission heart rate is an independent predictor for all-cause mortality, and HR ≥ 80 bpm is associated with improved all-cause mortality in patients in SR but not in AF
Summary
Association of heart rate (HR) with mortality in patients with acute coronary syndrome (ACS) and aged ≥ 80 years are underrepresented in clinical trials. Despite of the increased complexity of management in very elderly patients with acute coronary syndrome (ACS), data on those aged ≥ 80 years are limited, since these patients are often excluded from clinical trials [1,3]. Limited data showed that low (< 60 bpm) or high HR (≥ 70bpm, ≥ 80bpm or ≥ 90bpm) is a marker of high risk that needs more attention and management, and higher HR is highly predictive of higher shortand long-term mortality in patients with ACS [13,14,15,16] These studies were conducted in ACS patients aged < 80 years, and their results weren’t further analyse in sinus rhythm (SR) or a trial fibrillation (AF) subgroup and the cut off value of HR was mostly pre-defined before the study was conducted. We aimed to evaluate the association of HR in AF versus SR with all-cause mortality in octogenarian patients in the overall ACS setting
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