Key result
Admission heart rate ≤ 80 bpm was independently associated with a lower risk of all-cause mortality (HR 0.66) in octogenarian patients with acute coronary syndrome, with the benefit observed primarily in those with sinus rhythm.
Why the study?
Does an admission heart rate ≤ 80 bpm improve all-cause mortality in octogenarian patients with acute coronary syndrome in sinus rhythm versus atrial fibrillation?
Cohort (n=336)
No
Does an admission heart rate ≤ 80 bpm improve all-cause mortality in octogenarian patients with acute coronary syndrome in sinus rhythm versus atrial fibrillation?
Hazard Ratio: 0.66 (95% CI 0.47–0.9)
p-value: p=0.009
An admission heart rate ≤ 80 bpm is an independent predictor of improved long-term survival in octogenarian ACS patients with sinus rhythm, but this prognostic benefit is not observed in those with atrial fibrillation.
HR ≤80 bpm linked to lower mortality in SR but not AF among octogenarian ACS; hypothesis-generating for rhythm-specific targets, needs prospective validation.
INTRODUCTION: Association of heart rate (HR) with mortality in patients with acute coronary syndrome (ACS) and aged ≥ 80 years are underrepresented in clinical trials. We therefore aimed to investigate the association of HR in atrial fibrillation (AF) versus sinus rhythm (SR) with all-cause mortality in octogenarian patients with ACS. METHODS: A total of 336 patients with ACS patients and aged ≥ 80 years were enrolled into the current study. The end point of interest was death from any cause. Association of HR in AF versus SR with mortality was analyzed by Kaplan-Meier curve following log-rank test and multivariable Cox regression analysis. RESULTS: In total, 63 (87.5%) of patients with AF were dead and 147 (59.8%) of patients with SR were dead during the follow-up period. The best cut-off was 80 bpm, with a sensitivity of 62% and specificity of 66%. HR ≤ 80 bpm in SR but not in AF was associated with better outcome as compared with HR > 80 bpm (Chi-Square = 26.55, Log rank P < 0.001). In SR subgroup, the hazard ratios of HR ≤ 80 bpm were 0.51(95% CI 0.37-0.70, P < 0.001) adjusted for age, 0.46 (95%CI 0.33-0.63, P < 0.001) adjusted for gender, 0.62 (95%CI 0.42- 0.93, P = 0.020) adjusted for multivariables respectively. In AF subgroup, the hazard ratios of HR ≤ 80 bpm were 0.83(95% CI 0.49-1.38, P = 0.464) adjusted for age, 0.96 (95%CI 0.59-1.58, P = 0.882) adjusted for gender, 0.72(95% CI 0.41-1.26, P = 0.249) adjusted for multivariables respectively. CONCLUSION: The current study demonstrates that heart rate is an independent prognostic predictor for all-cause mortality, and HR ≤ 80 bpm is associated with improved outcome in SR but not in AF in octogenarian patients with ACS.
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Li et al. (2017) conducted a cohort in Acute coronary syndrome (n=336). Heart rate ≤ 80 bpm vs. Heart rate > 80 bpm was evaluated on All-cause mortality (HR 0.66, 95% CI 0.47-0.90, p=0.009). Admission heart rate ≤ 80 bpm was independently associated with a lower risk of all-cause mortality (HR 0.66) in octogenarian patients with acute coronary syndrome, with the benefit observed primarily in those with sinus rhythm.
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