Abstract
Background and aimsThe prognostic impact of pre-procedure heart rate (PHR) following percutaneous coronary intervention (PCI) has not yet been fully investigated. This post-hoc analysis sought to assess the impact of PHR on medium-term outcomes among patients having PCI, who were enrolled in the “all-comers” GLOBAL LEADERS trial. Methods and resultsThe primary endpoint (composite of all-cause death or new Q-wave myocardial infarction [MI]) and key secondary safety endpoint (bleeding according to Bleeding Academic Research Consortium [BARC] type 3 or 5) were assessed at 2 years. PHR was available in 15,855 patients, and when evaluated as a continuous variable (5 bpm increase) and following adjustment using multivariate Cox regression, it significantly correlated with the primary endpoint (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03–1.09, p < 0.001). Using dichotomous cut-off criteria, a PHR>67 bpm was associated with increased all-cause mortality (HR 1.38, 95%CI 1.13–1.69, p = 0.002) and more frequent new Q-wave MI (HR 1.41, 95%CI 1.02–1.93, p = 0.037). No significant association was found between PHR and BARC 3 or 5 bleeding (HR 1.04, 95% CI 0.99–1.09, p = 0.099). There was no interaction with the primary (p-inter = 0.236) or secondary endpoint (p-inter = 0.154) when high and low PHR was analyzed according to different antiplatelet strategies. ConclusionsElevated PHR was an independent predictor of all-cause mortality at 2 years following PCI in the “all-comer” GLOBAL LEADERS trial. The prognostic value of increased PHR on outcomes was not affected by the different antiplatelet strategies in this trial.
Highlights
Previous studies have demonstrated that resting heart rate is a risk factor for mortality in patients with coronary artery disease (CAD) [1,2,3], heart failure [4,5] and even in the general population [6,7]
In a large size contemporary “all-comer” population with both stable CAD and acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI) in GLOBAL LEADERS trial, we found: 1) elevated procedure heart rate (PHR) is an independent predictor of all-cause mortality and cardiovascular death; 2) each increase of 5 bpm in PHR is associated with a significant 7% increased risk of for all-cause mortality; 3) PHR > 67 bpm was an independent predictor of all-cause mortality, cardiovascular death and new Q-wave myocardial infarction (MI); 4) no significant relationship exists between PHR and bleeding events; and 5) the prognostic value of increased PHR on outcomes was not affected by the two antiplatelet strategies
Previous studies have demonstrated that heart rate was an in dependent predictor of adverse outcomes in various populations, in cluding patients with hypertension, CAD, left ventricular dysfunction and even in general populations [1,2,3,4,5,6,7,16,17]
Summary
Previous studies have demonstrated that resting heart rate is a risk factor for mortality in patients with coronary artery disease (CAD) [1,2,3], heart failure [4,5] and even in the general population [6,7]. The prognostic impact of heart rate on outcomes in a wide spectrum of CAD patients who underwent PCI has not yet been fully investigated. In this study, we aimed to evaluate the impact of PHR on 2-year clinical outcomes following PCI in the prospective, con temporary “all-comer” GLOBAL LEADERS trial. The prognostic impact of pre-procedure heart rate (PHR) following percutaneous coronary intervention (PCI) has not yet been fully investigated. This post-hoc analysis sought to assess the impact of PHR on medium-term outcomes among patients having PCI, who were enrolled in the “all-comers” GLOBAL LEADERS trial. Conclusions: Elevated PHR was an independent predictor of all-cause mortality at 2 years following PCI in the “all-comer” GLOBAL LEADERS trial. The prognostic value of increased PHR on outcomes was not affected by the different antiplatelet strategies in this trial
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
