Resting heart rate ≥75 bpm at 30 days after TAVR or SAVR independently predicted the 2-year composite of all-cause death, rehospitalization, or stroke (HR 1.26; 95% CI 1.05-1.52; p=0.015).
Cohort (n=3,170)
Yes
Does resting heart rate ≥75 bpm at 30 days post-procedure predict adverse cardiovascular outcomes in patients with severe symptomatic aortic stenosis treated with TAVR or SAVR?
Elevated resting heart rate (≥75 bpm) at 30 days following TAVR or SAVR is an independent predictor of mortality, rehospitalization, or stroke at 2 years.
Effect estimate: HR 1.26 (95% CI 1.05-1.52)
p-value: p=0.015
BackgroundElevated resting heart rate (RHR) is associated with adverse cardiovascular outcomes in patients with untreated aortic valve stenosis (AS). However, the impact of RHR following transcatheter (TAVR) or surgical aortic valve replacement (SAVR) on cardiovascular outcomes is unknown. We therefore sought to determine the effect of RHR at 30 days after aortic valve replacement (AVR) on 2-year outcomes in patients with severe symptomatic AS.MethodsThe study population consists of 3170 patients from the PARTNER 2 Trial and its embedded registries who underwent TAVR or SAVR for severe AS, and had available 12-lead electrocardiograms demonstrating sinus rhythm at 30 days post-procedure. Outcomes at 2 years were analyzed according to 30-day RHR modeled as a continuous variable and in groups (RHR ≥75 bpm and RHR <75 bpm).ResultsBy multivariable analysis, RHR ≥75 bpm at 30 days after AVR was an independent predictor of the composite endpoint of all-cause death, rehospitalization or stroke (hazard ratio HR 1.26, 95% confidence interval CI, 1.05–1.52, p = 0.015) and rehospitalization (HR 1.42, 95% CI, 1.12–1.79, p = 0.004). Similarly, RHR modeled as a continuous variable (per 5 bpm) remained an independent predictor of all-cause death, rehospitalization or stroke (adjusted HR 1.07, 95% CI, 1.03–1.11, p = 0.0007), and rehospitalization (adjusted HR 1.09, 95% CI, 1.04–1.14, p = 0.0003) at 2 years.ConclusionsIn patients with severe AS treated with TAVR or SAVR, resting heart rate at 30 days post-procedure was an independent predictor of the composite endpoint of all-cause death, rehospitalization or any stroke, and of rehospitalization at 2 years.
Macedo et al. (Wed,) conducted a cohort in severe symptomatic aortic valve stenosis (n=3,170). Resting heart rate ≥75 bpm vs. Resting heart rate <75 bpm was evaluated on composite endpoint of all-cause death, rehospitalization or stroke (HR 1.26, 95% CI 1.05-1.52, p=0.015). Resting heart rate ≥75 bpm at 30 days after TAVR or SAVR independently predicted the 2-year composite of all-cause death, rehospitalization, or stroke (HR 1.26; 95% CI 1.05-1.52; p=0.015).