Coronary artery disease
Usefulness of Postoperative Heart Rate as an Independent Predictor of Mortality After Coronary Bypass Grafting

https://doi.org/10.1016/j.amjcard.2010.05.026Get rights and content

Heart rate (HR) predicts mortality and cardiovascular events in the general population and in patients with coronary artery disease. However, little evidence is available for patients after coronary revascularization. The aim of this study was to assess the prognostic value of ambulatory postoperative HR after coronary artery bypass grafting. Data from a prospective cohort study enrolling patients who underwent nonurgent coronary artery bypass grafting from 1998 to 2002 were analyzed. Baseline postoperative HR was measured 2 months after surgery, and patients were followed annually thereafter. The primary outcome was all-cause mortality. The secondary outcome combined any of the following events: death, nonfatal acute coronary syndromes, stroke or transient ischemic attack, secondary coronary revascularization, or vascular surgery. Seven hundred ninety-four patients (mean age 65.8 ± 9.3 years) were eligible for follow-up, predominantly men (84.1%). The mean follow-up duration was 3.2 ± 1.3 years, during which 40 patients (5.0%) died. In the univariate analysis, HR >90 beats/min was significantly associated with all outcomes. After adjustments for major confounding factors and the use of β blockers, postoperative HR >90 beats/min remained significantly associated with the secondary outcome (hazard ratio 2.26, 95% confidence interval 1.04 to 4.91, p = 0.04). Association of postoperative HR >90 beats/min with all-cause mortality was only borderline in the multivariate analysis (hazard ratio 3.57, 95% confidence interval 0.90 to 14.17, p = 0.07), because of the limited sample population size. In conclusion, postoperative HR >90 beats/min may be associated with poor prognoses in patients with coronary artery disease, even after surgical revascularization.

Section snippets

Methods

This observational cohort study was designed for the risk prediction of perioperative and postoperative events after CABG. Data collection and variables definition have been described in detail elsewhere.7, 8

Briefly, we included all patients referred to our department for CABG from September 1998 to August 2002 in a prospective longitudinal cohort study.

Clinical recording began approximately 1 month before surgery in case of nonurgent CABG, during the anesthetist outpatient visit, and was

Results

Among the 1,022 patients enrolled, 32 died during the first month after CABG and were thus excluded from this analysis. Thirty-five additional patients were excluded because of missing data regarding preoperative (n = 5) and postoperative (n = 30) HR. Among the remaining 955 patients, 161 underwent concomitant valvular and/or vascular surgery and were thus excluded from statistical analysis. The baseline characteristics of the remaining 794 patients are listed in Table 1. Mean preoperative and

Discussion

In this study, we found that postoperative HR at rest measured 2 months after CABG was associated with long-term cardiovascular events. Higher HR was also associated with mortality, but this association was not found independent from other covariates. The strongest independent association between cardiovascular events and HR was demonstrated for values >90 beats/min. To our knowledge, this is the first specific study addressing the predictive value of HR in the setting of patients with coronary

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      The major findings from the present analysis from the EXCEL trial, in which the association between RHR at discharge and clinical outcomes following revascularization for LMCAD with PCI or CABG was examined, are as follows: (i) Increasing RHR at discharge was an independent predictor of a higher rate of 3-year adverse outcomes, including mortality; (ii) revascularization modality (PCI vs CABG) did not modulate the discharge RHR-related risk of adverse outcomes; and (iii) utilization of beta blockers did not affect the association between discharge RHR and adverse outcomes. Previous studies have indicated that increasing baseline or discharge RHR in patients treated with either PCI8–10,15 or CABG16–18 portends an increased risk of adverse clinical outcomes. To our knowledge, the present study is the first study to examine the clinical impact of discharge RHR following percutaneous or surgical revascularization in patients with LMCAD.

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      2018, American Journal of Cardiology
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      Our secondary analysis findings support those of several studies that propose a HR threshold of 70 beats/min beyond which poorer outcome can be anticipated in patients with CAD.6,7,9 This threshold was previously thought to be higher, with other reports suggesting a range from 75 to 90 beats/min.2,3,10,11 Most importantly, our findings suggest that this threshold remains present even in a cohort with lower rates of left ventricular (LV) dysfunction and heart failure.

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