title: Preoperative heart rate and myocardial injury after non-cardiac surgery: results of a predefined secondary analysis of the VISION study.
abstract: Increased baseline heart rate is associated with cardiovascular risk and all-cause mortality in the general population. We hypothesized that elevated preoperative heart rate increases the risk of myocardial injury after non-cardiac surgery (MINS).
  
  
  
  We performed a secondary analysis of a prospective international cohort study of patients aged ≥45 yr undergoing non-cardiac surgery. Preoperative heart rate was defined as the last measurement before induction of anaesthesia. The sample was divided into deciles by heart rate. Multivariable logistic regression models were used to determine relationships between preoperative heart rate and MINS (determined by serum troponin concentration), myocardial infarction (MI), and death within 30 days of surgery. Separate models were used to test the relationship between these outcomes and predefined binary heart rate thresholds.
  
  
  
  Patients with missing outcomes or heart rate data were excluded from respective analyses. Of 15 087 patients, 1197 (7.9%) sustained MINS, 454 of 16 007 patients (2.8%) sustained MI, and 315 of 16 037 patients (2.0%) died. The highest heart rate decile (>96 beats min(-1)) was independently associated with MINS {odds ratio (OR) 1.48 [1.23-1.77]; P<0.01}, MI (OR 1.71 [1.34-2.18]; P<0.01), and mortality (OR 3.16 [2.45-4.07]; P<0.01). The lowest decile (<60 beats min(-1)) was independently associated with reduced mortality (OR 0.50 [0.29-0.88]; P=0.02), but not MINS or MI. The predefined binary thresholds were also associated with MINS, but more weakly than the highest heart rate decile.
  
  
  
  Preoperative heart rate >96 beats min(-1) is associated with MINS, MI, and mortality after non-cardiac surgery. This association persists after accounting for potential confounding factors.
  
  
  
  NCT00512109.
authors.affiliation: William Harvey Research Institute, Queen Mary University of London, London, UK.
authors.forename: T E F
authors.initials: TE
authors.lastname: Abbott
authors.affiliation: William Harvey Research Institute, Queen Mary University of London, London, UK.
authors.forename: G L
authors.initials: GL
authors.lastname: Ackland
authors.affiliation: Barts Health NHS Trust, London, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Archbold
authors.affiliation: Barts Health NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wragg
authors.affiliation: William Harvey Research Institute, Queen Mary University of London, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Kam
authors.affiliation: William Harvey Research Institute, Queen Mary University of London, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Ahmad
authors.affiliation: Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan.
authors.forename: A W
authors.initials: AW
authors.lastname: Khan
authors.affiliation: Barts Health NHS Trust, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Niebrzegowska
authors.affiliation: Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: R N
authors.initials: RN
authors.lastname: Rodseth
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.affiliation: William Harvey Research Institute, Queen Mary University of London, London, UK r.pearse@qmul.ac.uk.
authors.forename: R M
authors.initials: RM
authors.lastname: Pearse
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative
keywords: heart rate; observational study; surgery