Prognostic Value of Mean Heart Rate by Holter Monitoring After STEMI

Mean heart rate (MHR) monitoring of patients with ST-segment elevation myocardial infarction (STEMI) with a Holter was found to have prognostic value, according to a study published in Clinical Research in Cardiology.

The data of 1013 patients who presented with STEMI within 12 hours of symptom onset and received acute coronary revascularization at the First Affiliated Hospital of Chongqing Medical University in China between 2015 and 2018 were retrospectively analyzed. Patients were evaluated with echocardiography. MHR was monitored with a Holter for a minimum of 24 hours during the first 5 days of hospitalization. Patients were evaluated after a median of 28.3 months for clinical outcomes, adverse events, and mortality.

In this cohort, 244 patients had MHR <66 bpm (Q1), 312 had MHR between 66 and 72 bpm (Q2), 211 had MHR between 73 and 78 bpm (Q3), and 246 had MHR >78 bpm (Q4). There was a greater percentage of women in the Q4 vs other groups (P =.035). In the Q4 group, there were also fewer smokers (P =.008), and patients had lower systolic blood pressure at admission (P =.034) than in the other 3 groups.

Patients in this cohort had anterior (Q1: 41.8%%; Q2: 42.6%%; Q3: 59.2%; Q4: 62.2%; P <.001) and inferior (Q1: 54.1%; Q2: 54.8%; Q3: 40.3%; Q4: 35.4%; P <.001) myocardial infarction, as assessed on electrocardiography. STEMI most commonly implicated the left anterior descending artery (Q1: 42.6%; Q2: 42.3%; Q3: 56.9%; Q4: 58.9%; P =.001) or right coronary artery (Q1: 45.1%; Q2: 45.5%; Q3: 33.6%; Q4: 29.7%).

At 30 days after discharge, all-cause mortality was 5.7% among patients in Q4, which was elevated compared with other groups (Q1: 1.2%, Q2: 1.6%, Q3: 1.4%; P =.003) and remained elevated in this group at the long-term follow-up (16.3%) compared with other groups (Q1: 7.4%, Q2: 6.1%, Q3: 6.6%; P <.001).

All-cause mortality was associated with glomerular filtration <60 mL/min/1.73 m² (hazard ratio [HR], 4.260; 95% CI, 2.010-9.029; P <.001), vasopressor use (HR, 2.705; 95% CI, 1.418-5.159; P =.003), MHR >78 bpm (HR, 2.170; 95% CI, 1.416-3.324; P <.001), age > 65 years (HR, 1.992; 95% CI, 1.267-3.131; P =.003), left ventricular ejection fraction <50% (HR, 1.938; 95% CI, 1.243-3.023; P =.004), and brain natriuretic peptide >100 pg/mL (HR, 1.871; 95% CI, 1.162-3.012; P =.010).

MHR >78 bpm was associated with an increased risk for lower cumulative survival (HR, 2.692; 95% CI, 1.779-4.073; P <.001).

MHR assessed with Holter better predicted all-cause mortality (area under the receiving operator characteristic curve [AUC], 0.672; P <.001) than heart rate at admission (AUC, 0.556; P =.101) or at discharge (AUC, 0.578; P =.022).

This study may have been limited by the lack of information on medication dosing or titration.

“MHR based on Holter monitoring provided important prognostic value and MHR>78 bpm was independently associated with increased risk of long-term all-cause mortality in patients with STEMI undergoing revascularization therapy, and MHR had better predictive validity compared with admission or discharge heart rate,” concluded the study authors.

Reference

Shen J, Liu G, Yang Y, et al. Prognostic impact of mean heart rate by Holter monitoring on long‑term outcome in patients with ST‑segment elevation myocardial infarction undergoing percutaneous coronary intervention. [published online February 6, 2021] Clin Res Cardiol. doi:10.1007/s00392-021-01806-1