title: Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction. Treatment regimens in German chest pain units.
abstract: BACKGROUND
  Higher heart rates on admission have been associated with poor outcomes in patients with an acute coronary syndrome in previous cohorts. Whether such a linear relationship still exists in contemporary high-level care is unclear.
  
  
  METHODS
  Prospectively collected data from patients presenting with myocardial infarction (MI) in centers participating in the Chest Pain Unit (CPU) Registry between December 2008 and July 2014 were analyzed. Patients were classified according to their initial heart rate (I: < 50; II: 50-69; III: 70-89; IV: ≥ 90 bpm). A total of 6,168 patients out of 30,339 patients presenting to 38 centers were included in the study.
  
  
  RESULTS
  Patients in group IV had more comorbidities, while patients in group I more often had a history of MI. Patients in the lowest heart rate group presented significantly earlier to the hospital (4 h 31 min vs. 7 h 37 min; p < 0.05) and had the highest rate of interventions. The overall survival after 3 months was significantly worse in group IV after adjusting for baseline variables. In the subgroup analysis, heart rate was a prognostic factor in the non-ST-segment elevation MI group but not in the ST-segment elevation MI group. The correlation between heart rate and major adverse cardiac events followed a J-shaped curve with worst outcomes in the lowest and highest heart rate groups.
  
  
  CONCLUSIONS
  Patients admitted to a dedicated CPU with the diagnosis of MI and a heart rate > 90 bpm experience reduced survival at 3 months despite optimal treatment. Patients with bradycardia also seem to be at increased risk for cardiovascular events despite much earlier presentation and treatment.
authors.affiliation: 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Perne
authors.affiliation: 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: F P
authors.initials: FP
authors.lastname: Schmidt
authors.affiliation: Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hochadel
authors.affiliation: 3rd Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, Vivantes-Klinikum Neukölln, Berlin, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Darius
authors.affiliation: 2nd Department of Medicine, University Hospital of Regensburg, Regensburg, Germany.
authors.forename: L S
authors.initials: LS
authors.lastname: Maier
authors.affiliation: Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: Institute for Pathophysiology, West German Heart and Vascular Center University Duisburg-Essen, Essen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Heusch
authors.affiliation: CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Voigtländer
authors.affiliation: Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Mudra
authors.affiliation: 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Gori
authors.affiliation: Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Senges
authors.affiliation: 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany. tmuenzel@uni-mainz.de.|2. Medical Clinic for Cardiology, Angiology and Intensive Care, Langenbeckstrasse 1, 55131, Mainz, Germany. tmuenzel@uni-mainz.de.
authors.forename: T
authors.initials: T
authors.lastname: Münzel
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D004632:Emergency Medical Services; D005260:Female; D005858:Germany / Q000453:epidemiology; D006339:Heart Rate; D000070276:Heart Rate Determination / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D010343:Patient Admission; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Chest Pain Unit; Heart rate; Mortality; Outcome