Association of Heart Rate Recovery Assessed by Cardiopulmonary Exercise Testing With Periprocedural Myocardial Infarction After an Elective Percutaneous Coronary Intervention

Aim/Background Periprocedural myocardial infarction (PMI) remains a significant complication of elective percutaneous coronary intervention (PCI) procedures and is linked to increased morbidity and mortality. Heart rate recovery (HRR), reflecting autonomic function and parasympathetic reactivation, has been established to predict adverse cardiovascular outcomes. This study investigates the association between HRR, assessed through cardiopulmonary exercise testing (CPET), and the occurrence of PMI in patients undergoing elective PCI. Materials and Methods This retrospective observational study included 401 patients who underwent elective PCI between January 2022 and September 2024. HRR was measured at 1‐ and 3‐min intervals following CPET. Baseline demographic, clinical, and laboratory data were analyzed alongside procedural variables. PMI was defined based on the Fourth Universal Definition of Myocardial Infarction. Statistical analyses, including multivariate logistic regression and receiver operating characteristics (ROC) curve analysis, were performed to assess the predictive value of HRR. Results Patients with PMI exhibited significantly lower HRR at both 1 min (11.12 ± 3.25 vs. 14.21 ± 4.22, p < 0.001) and 3 min (42.99 ± 13.17 vs. 48.36 ± 9.72, p < 0.001) after peak exercise compared to those without PMI. ROC analysis revealed HRR as a reliable predictor of PMI, with AUCs of 0.723 (1 min) and 0.616 (3 min). Multivariate analysis confirmed HRR at 1 min (OR: 0.744, 95% CI: 0.617–0.897, p = 0.002) and 3 min (OR: 0.950, 95% CI: 0.905–0.999, p = 0.044) as independent predictors of PMI. Conclusion HRR measured by CPET independently predicts PMI in patients undergoing elective PCI. Incorporating HRR into preoperative risk assessments could enhance clinical decision‐making and improve procedural outcomes. Future studies are needed to explore its integration into standard PCI protocols for better risk stratification.