title: Admission heart rate predicts mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction: an observational study.
abstract: BACKGROUND
  The prognostic value of admission heart rate (HR) on long-term mortality in ST-elevation myocardial infarction (STEMI) remains uncertain in the modern era of primary percutaneous coronary intervention (PPCI). This study aimed to assess the predictive value of admission HR on long-term mortality following PPCI and the influence of beta-blockers on postdischarge survival.
  
  
  METHODS
  Retrospective analysis of prospectively collected data on 2310 PPCI-treated STEMI patients at a regional tertiary center between March 2008 and June 2010.
  
  
  RESULTS
  Patients were classified according to admission HR into either low (≤70 beat per minute [bpm], n = 1015) or high HR group (>70 bpm, n = 1295). At a median follow-up of 559 days, all-cause mortality was 7.0% in the low HR group compared to 12.7% in the high-HR group. In the Cox proportional hazard model, adjusted for several confounders, the hazard ratio (95% confidence interval) for all-cause mortality in the high HR group was 1.59 (1.15-2.20; P = 0.005). Every 10-bpm increase in admission HR was associated with 17% increase in all-cause mortality. Beta-blockers on discharge was associated with a reduction in postdischarge mortality only in the high HR group (adjusted hazard ratio, 0.49 [0.31-0.77; P = 0.002]), but not in the low HR group (adjusted hazard ratio, 0.74 [0.37-1.49; P = 0.33]).
  
  
  CONCLUSIONS
  Elevated admission heart rate in PPCI-treated STEMI patients is associated with long-term all-cause mortality. Beta blocker therapy improved postdischarge survival in patients with elevated admission heart rate.
authors.affiliation: Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne, UK.
authors.forename: Awsan
authors.initials: A
authors.lastname: Noman
authors.forename: Karthik
authors.initials: K
authors.lastname: Balasubramaniam
authors.forename: Rajiv
authors.initials: R
authors.lastname: Das
authors.forename: Donald
authors.initials: D
authors.lastname: Ang
authors.forename: Vijay
authors.initials: V
authors.lastname: Kunadian
authors.forename: Taida
authors.initials: T
authors.lastname: Ivanauskiene
authors.forename: Azfar G
authors.initials: AG
authors.lastname: Zaman
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: ST-elevation myocardial infarction; beta blocker; heart rate; mortality; primary percutaneous coronary intervention