Key result
Higher heart rates at hospital admission in patients with timely reperfused STEMI are independently associated with a reduction in salvaged myocardium (OR 0.95 per bpm increase).
Why the study?
Does higher heart rate at presentation reduce myocardial salvage in timely reperfused patients with STEMI?
Observational (n=187)
No
Does higher heart rate at presentation reduce myocardial salvage in timely reperfused patients with STEMI?
Higher heart rates at presentation in STEMI patients undergoing primary PCI are independently associated with reduced myocardial salvage as assessed by CMR.
Higher admission heart rate associated with less myocardial salvage in reperfused STEMI; hypothesis-generating and requires prospective validation.
BACKGROUND: Previous studies evaluating the progression of the necrotic wave in relation to heart rate were carried out only in animal models of ST-elevated myocardial infarction (STEMI). Aim of the study was to investigate changes of myocardial salvage in relation to different heart rates at hospital admission in timely reperfused patients with STEMI by using cardiovascular magnetic resonance (CMR). METHODS: One hundred-eighty-seven patients with STEMI successfully and timely treated with primary coronary angioplasty underwent CMR five days after hospital admission. According to the heart rate at presentation, patients were subcategorized into 5 quintiles: <55 bpm (group I, n = 44), 55-64 bpm (group II, n = 35), 65-74 bpm (group III, n = 35), 75-84 bpm (group IV, n = 37), ≥85 bpm (group V, n = 36). Area at risk, infarct size, microvascular obstruction (MVO) and myocardium salvaged index (MSI) were assessed by CMR using standard sequences. RESULTS: Lower heart rates at presentation were associated with a bigger amount of myocardial salvage after reperfusion. MSI progressively decreased as the heart rates increased (0.54 group I, 0.46 group II, 0.38 group III, 0.34 group IV, 0.32 group V, p<0.001). Stepwise multivariable analysis showed heart rate, peak troponin and the presence of MVO were independent predictor of myocardial salvage. No changes related to heart rate were observed in relation to area at risk and infarct size. CONCLUSIONS: High heart rates registered before performing coronary angioplasty in timely reperfused patients with STEMI are associated with a reduction in salvaged myocardium. In particular, salvaged myocardium significantly reduced when heart rate at presentation is ≥85 bpm.
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Arcari et al. (2015) conducted an observational in ST-Segment Elevation Myocardial Infarction (STEMI) (n=187). Heart rate at hospital admission vs. Lower heart rate was evaluated on Myocardial salvage index > median (0.41) (OR 0.95, 95% CI 0.92-0.97, p=0.001). Higher heart rates at hospital admission in patients with timely reperfused STEMI are independently associated with a reduction in salvaged myocardium (OR 0.95 per bpm increase).
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