Heart rate at discharge and long-term prognosis following percutaneous coronary intervention in stable and acute coronary syndromes--results from the BASKET PROVE trial

Publication

Heart rate at discharge and long-term prognosis following percutaneous coronary intervention in stable and acute coronary syndromes--results from the BASKET PROVE trial

Journal Paper/Review - Jul 11, 2013

Jensen Magnus Thorsten, Galatius Søren, Pfisterer Matthias, Erne Paul, De Servi Stefano, Bertel Osmund, Fahrni Gregor, Zurek Marzena, Rickli Hans, Soerensen Rikke, Pedersen Sune, Jensen Jan Skov, Iversen Allan, Wanitschek Maria, Alber Hannes, Sandsten Karl Erik, Kaiser Christoph, BASKET-PROVE Investigators

Citation

Jensen M, Galatius S, Pfisterer M, Erne P, De Servi S, Bertel O, Fahrni G, Zurek M, Rickli H, Soerensen R, Pedersen S, Jensen J, Iversen A, Wanitschek M, Alber H, Sandsten K, Kaiser C, BASKET-PROVE Investigators. Heart rate at discharge and long-term prognosis following percutaneous coronary intervention in stable and acute coronary syndromes--results from the BASKET PROVE trial. Int J Cardiol 2013; 168:3802-6.

Type

Journal Paper/Review (English)

Journal

Int J Cardiol 2013; 168

Publication Date

Jul 11, 2013

Issn Electronic

1874-1754

Pages

3802-6

Brief description/objective

BACKGROUND
Elevated heart rate (HR) is associated with mortality in a number of heart diseases. We examined the long-term prognostic significance of HR at discharge in a contemporary population of patients with stable angina (SAP), non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI) revascularized with percutaneous coronary intervention (PCI).

METHODS
Patients from the BASKET-PROVE trial, an 11-center randomized all-comers trial comparing bare-metal and drug-eluting stenting in large coronary vessels, were included. Discharge HR was determined from a resting ECG. Long-term outcomes (7 days to 2 years) were evaluated for all-cause mortality and cardiovascular death and non-fatal myocardial infarction.

RESULTS
A total of 2029 patients with sinus rhythm were included, 722 (35.6%) SAP, 647 (31.9%) NSTE-ACS, and 660 (32.5%) STEMI. Elevated discharge HR was associated significantly with all-cause mortality: when compared to a reference of <60 beats per minute (bpm), the adjusted hazard ratios were (95% CI) 4.5 (1.5-13.5, p=0.006) for 60-69 bpm, 3.8 (1.2-11.9, p=0.022) for 70-79 bpm, 4.3 (1.2-15.6, p=0.025) for 80-89 bpm, and 16.9 (5.2-55.0, p<0.001) for >90 bpm. For cardiovascular death/myocardial infarction, a discharge HR >90 bpm was associated with a hazard ratio of 6.2 (2.5-15.5, p<0.001) compared to a HR <60 bpm. No interaction was found for disease presentation, diabetes or betablocker use.

CONCLUSION
In patients revascularized with PCI for stable angina or acute coronary syndromes an elevated discharge HR was independently associated with poor prognosis. Conversely, a HR <60 bpm at discharge was associated with a good long-term prognosis irrespective of indication for PCI.