Key result
Elevated early postoperative maximum heart rate (>100-110 bpm) was not significantly associated with in-hospital MACCEs after elective CABG (OR 1.43; 95% CI 0.95-2.15).
Why the study?
Elevated perioperative heart rate potentially causes myocardial injury, but large multicenter studies evaluating early postoperative heart rate and MACCEs are lacking.
Does elevated early postoperative heart rate increase the risk of in-hospital major adverse cardiac and cerebrovascular events in patients after elective CABG?
Cohort (n=2,585)
Yes
Does elevated early postoperative heart rate increase the risk of in-hospital major adverse cardiac and cerebrovascular events in patients after elective CABG?
Early postoperative heart rate parameters within 24 hours of ICU admission were not significantly associated with in-hospital major adverse cardiac and cerebrovascular events after elective CABG.
Answers are grounded in this paper and cite their sources.
Early postoperative heart rate monitoring may not guide MACCE prevention after CABG; leaves open alternative mechanisms and need for prospective trials.
BACKGROUND: Elevated perioperative heart rate potentially causes perioperative myocardial injury because of imbalance in oxygen supply and demand. However, large multicenter studies evaluating early postoperative heart rate and major adverse cardiac and cerebrovascular events (MACCEs) are lacking. OBJECTIVE: To assess the associations of 4 postoperative heart rate assessment methods with in-hospital MACCEs after elective coronary artery bypass grafting (CABG). METHODS: Using data from the eICU Collaborative Research Database in the United States from 2014 to 2015, the study evaluated postoperative heart rate measured during hospitalization within 24 hours after intensive care unit admission. Four heart rate assessment methods were evaluated: maximum heart rate, duration above heart rate 100/min, area above heart rate 100/min, and time-weighted average heart rate. The outcome was in-hospital MACCEs, defined as a composite of in-hospital death, myocardial infarction, angina, arrhythmia, heart failure, stroke, cardiac arrest, or repeat revascularization. RESULTS: Among 2585 patients, the crude rate of in-hospital MACCEs was 6.2%. In multivariable logistic regression analysis, the adjusted odds ratios (95% CI) for in-hospital MAC-CEs assessed by maximum heart rate in each heart rate category (beats per minute: >100-110, >110-120, >120-130, and >130) were 1.43 (0.95-2.15), 0.98 (0.56-1.64), 1.47 (0.76-2.69), and 1.71 (0.80-3.35), respectively. Similarly, none of the other 3 methods were associated with MACCEs. CONCLUSIONS: More research is needed to assess the usefulness of heart rate measurement in patients after CABG.
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Morita et al. (2022) conducted a cohort in Elective coronary artery bypass grafting (CABG) (n=2,585). Elevated early postoperative heart rate vs. Lower heart rate was evaluated on In-hospital MACCEs, defined as a composite of in-hospital death, myocardial infarction, angina, arrhythmia, heart failure, stroke, cardiac arrest, or repeat revascularization (OR 1.43, 95% CI 0.95-2.15). Elevated early postoperative maximum heart rate (>100-110 bpm) was not significantly associated with in-hospital MACCEs after elective CABG (OR 1.43; 95% CI 0.95-2.15).
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