Previous studies have shown elevated admission heart rate (HR) was associated with worse outcome in patients with myocardial infarction (MI). However, the prognostic value of mean heart rate (MHR) with Holter monitoring remains unclear.
Our present study aims to evaluate the impact of MHR by Holter monitoring on long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI).
1013 STEMI patients were divided into four groups according to the quartiles of MHR by Holter monitoring, Q1 (< 66 bpm), Q2 66–72 bpm), Q3 (73–78 bpm), and Q4 (> 78 bpm). The endpoint was long-term all-cause mortality. The predictive value of admission HR, discharge HR, and MHR was compared with receiver operating characteristic (ROC) curves.
Patients in Q4 were more likely to present with anterior MI, high Killip class, relatively lower admission blood pressure, significantly increased troponin I, B-type natriuretic peptide, and decreased left ventricular ejection fraction. During a median of 28.3 months follow up period, 91 patients (8.9%) died. The mortality in Q4 was significantly higher than in the other three groups (P < 0.001). After multivariate adjustment, Q4 was associated with a 1.0-fold increased risk of long-term all-cause mortality (HR = 2.096, 95% CI 1.190–3.691, P = 0.010). ROC analysis shows MHR with Holter (AUC = 0.672) was superior to admission HR (AUC = 0.556) or discharge HR (AUC = 0.578).
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, and its predictive validity was superior to admission or discharge HR.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Jensen MT, Marott JL, Allin KH, Nordestgaard BG, Jensen GB (2012) Resting heart rate is associated with cardiovascular and all-cause mortality after adjusting for inflammatory markers: the Copenhagen City Heart Study. Eur J Prev Cardiol 19:102–108. https://doi.org/10.1177/1741826710394274
Kannel WB, Kannel C, Paffenbarger RJ, Cupples LA (1987) Heart rate and cardiovascular mortality: the Framingham Study. Am Heart J 113:1489–1494. https://doi.org/10.1016/0002-8703(87)90666-1
Greenland P, Daviglus ML, Dyer AR, Liu K, Huang CF, Goldberger JJ, Stamler J (1999) Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality: the Chicago Heart Association Detection Project in Industry. Am J Epidemiol 149:853–862. https://doi.org/10.1093/oxfordjournals.aje.a009901
Diaz A, Bourassa MG, Guertin MC, Tardif JC (2005) Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease. Eur Heart J 26:967–974. https://doi.org/10.1093/eurheartj/ehi190
Ryu M, Bayasgalan G, Kimm H, Nam CM, Ohrr H (2016) Association of resting heart rate and hypertension stages on all-cause and cardiovascular mortality among elderly Koreans: the Kangwha Cohort Study. J Geriatr Cardiol 13:573–579
Bohm M, Swedberg K, Komajda M, Borer JS, Ford I, Dubost-Brama A, Lerebours G, Tavazzi L (2010) Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial. Lancet 376:886–894. https://doi.org/10.1016/S0140-6736(10)61259-7
Fox K, Ford I, Steg PG, Tendera M, Robertson M, Ferrari R (2008) Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet 372:817–821. https://doi.org/10.1016/S0140-6736(08)61171-X
Crimm A, Severance HJ, Coffey K, McKinnis R, Wagner GS, Califf RM (1984) Prognostic significance of isolated sinus tachycardia during first three days of acute myocardial infarction. Am J Med 76:983–988. https://doi.org/10.1016/0002-9343(84)90846-5
Jensen MT, Pereira M, Araujo C, Malmivaara A, Ferrieres J, Degano IR, Kirchberger I, Farmakis D, Garel P, Torre M, Marrugat J, Azevedo A (2018) Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study. Eur Heart J Acute Cardiovasc Care 7:149–157. https://doi.org/10.1177/2048872616672077
Wang SL, Wang CL, Wang PL, Xu H, Du JP, Zhang DW, Gao ZY, Zhang L, Fu CG, Chen KJ, Shi DZ (2016) Resting heart rate associates with one-year risk of major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention. Exp Biol Med (Maywood) 241:478–484. https://doi.org/10.1177/1535370215617563
Jensen MT, Kaiser C, Sandsten KE, Alber H, Wanitschek M, Iversen A, Jensen JS, Pedersen S, Soerensen R, Rickli H, Zurek M, Fahrni G, Bertel O, De Servi S, Erne P, Pfisterer M, Galatius S (2013) 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 168:3802–3806. https://doi.org/10.1016/j.ijcard.2013.06.034
Carlson N, Dixen U, Marott JL, Jensen MT, Jensen GB (2014) Predictive value of casual ECG-based resting heart rate compared with resting heart rate obtained from Holter recording. Scand J Clin Lab Invest 74:163–169. https://doi.org/10.3109/00365513.2013.867531
Palatini P, Reboldi G, Beilin LJ, Eguchi K, Imai Y, Kario K, Ohkubo T, Pierdomenico SD, Saladini F, Schwartz JE, Wing L, Verdecchia P (2013) Predictive value of night-time heart rate for cardiovascular events in hypertension. The ABP-International study. Int J Cardiol 168:1490–1495. https://doi.org/10.1016/j.ijcard.2012.12.103
Bohm M, Schwantke I, Mahfoud F, Lauder L, Wagenpfeil S, de la Sierra A, Vinyoles E, Gorostidi M, Segura J, Ruilope LM (2020) Association of clinic and ambulatory heart rate parameters with mortality in hypertension. J Hypertens. https://doi.org/10.1097/HJH.0000000000002565
Pastor-Perez FJ, Manzano-Fernandez S, Goya-Esteban R, Pascual-Figal DA, Bravo IP, Barquero-Perez O, Rojo-Alvarez JL, Januzzi JL, Chavarri MV, Garcia-Alberola A (2013) Heart rate control in chronic heart failure: resting versus mean heart rate with prolonged ambulatory ECG recording. Int J Cardiol 170:e45–e47. https://doi.org/10.1016/j.ijcard.2013.10.071
Copie X, Hnatkova K, Staunton A, Fei L, Camm AJ, Malik M (1996) Predictive power of increased heart rate versus depressed left ventricular ejection fraction and heart rate variability for risk stratification after myocardial infarction. Results of a two-year follow-up study. J Am Coll Cardiol 27:270–276. https://doi.org/10.1016/0735-1097(95)00454-8
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Ting HH, O’Gara PT, Kushner FG, Ascheim DD, Brindis RG, Casey DJ, Chung MK, de Lemos JA, Diercks DB, Fang JC, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX (2016) 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of st-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the society for cardiovascular angiography and interventions. Circulation 133:1135–1147. https://doi.org/10.1161/CIR.0000000000000336
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio A, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimsky P (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39:119–177. https://doi.org/10.1093/eurheartj/ehx393
China Society of Cardiology of Chinese Medical Association (2015) Guideline on the diagnosis and therapy of ST-segment elevation myocardial infarction. Zhonghua Xin Xue Guan Bing Za Zhi 43:380–393
Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, Giugliano RP, McCabe CH, Braunwald E (2000) TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 102:2031–2037. https://doi.org/10.1161/01.cir.102.17.2031
Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van De Werf F, Avezum A, Goodman SG, Flather MD, Fox KA (2003) Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 163:2345–2353. https://doi.org/10.1001/archinte.163.19.2345
Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK, Wang TY, Gibler WB, Ohman EM, Roe MT, Pollack CJ, Peterson ED, Alexander KP (2009) Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with early implementation of the ACC/AHA Guidelines) bleeding score. Circulation 119:1873–1882. https://doi.org/10.1161/CIRCULATIONAHA.108.828541
Morrow DA, Antman EM, Giugliano RP, Cairns R, Charlesworth A, Murphy SA, de Lemos JA, McCabe CH, Braunwald E (2001) A simple risk index for rapid initial triage of patients with ST-elevation myocardial infarction: an InTIME II substudy. Lancet 358:1571–1575. https://doi.org/10.1016/S0140-6736(01)06649-1
Disegni E, Goldbourt U, Reicher-Reiss H, Kaplinsky E, Zion M, Boyko V, Behar S (1995) The predictive value of admission heart rate on mortality in patients with acute myocardial infarction. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial. J Clin Epidemiol 48:1197–1205. https://doi.org/10.1016/0895-4356(95)00022-v
Timoteo AT, Toste A, Ramos R, Oliveira JA, Ferreira ML, Ferreira RC (2011) Admission heart rate as a predictor of mortality in patients with acute coronary syndromes. Acute Card Care 13:205–210. https://doi.org/10.3109/17482941.2011.628028
Han Z, Yan-min Y, Jun Z, Li-sheng L, Hui-qiong T, Yao L (2012) Prognostic value of admission heart rate in patients with ST-segment elevation myocardial infarction: role of type 2 diabetes mellitus. BMC Cardiovasc Disord 12:104. https://doi.org/10.1186/1471-2261-12-104
Jabre P, Roger VL, Weston SA, Adnet F, Jiang R, Vivien B, Empana JP, Jouven X (2014) Resting heart rate in first year survivors of myocardial infarction and long-term mortality: a community study. Mayo Clin Proc 89:1655–1663. https://doi.org/10.1016/j.mayocp.2014.07.017
Solomon SD, Zelenkofske S, McMurray JJ, Finn PV, Velazquez E, Ertl G, Harsanyi A, Rouleau JL, Maggioni A, Kober L, White H, Van de Werf F, Pieper K, Califf RM, Pfeffer MA (2005) Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med 352:2581–2588. https://doi.org/10.1056/NEJMoa043938
Song J, Murugiah K, Hu S, Gao Y, Li X, Krumholz HM, Zheng X (2020) Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China. Heart. https://doi.org/10.1136/heartjnl-2020-317165
Solomon MD, Leong TK, Levin E, Rana JS, Jaffe MG, Sidney S, Sung SH, Lee C, DeMaria A, Go AS (2020) Cumulative adherence to secondary prevention guidelines and mortality after acute myocardial infarction. J Am Heart Assoc 9:e14415. https://doi.org/10.1161/JAHA.119.014415
Marquis-Gravel G, Dalgaard F, Jones AD, Lokhnygina Y, James SK, Harrington RA, Wallentin L, Steg PG, Lopes RD, Storey RF, Goodman SG, Mahaffey KW, Tricoci P, White HD, Armstrong PW, Ohman EM, Alexander JH, Roe MT (2020) Post-discharge bleeding and mortality following acute coronary syndromes with or without PCI. J Am Coll Cardiol 76:162–171. https://doi.org/10.1016/j.jacc.2020.05.031
Khera R, Wang Y, Bernheim SM, Lin Z, Krumholz HM (2020) Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States. BMJ 368:l6831. https://doi.org/10.1136/bmj.l6831
Panza JA, Diodati JG, Callahan TS, Epstein SE, Quyyumi AA (1992) Role of increases in heart rate in determining the occurrence and frequency of myocardial ischemia during daily life in patients with stable coronary artery disease. J Am Coll Cardiol 20:1092–1098. https://doi.org/10.1016/0735-1097(92)90363-r
Maroko PR, Kjekshus JK, Sobel BE, Watanabe T, Covell JW, Ross JJ, Braunwald E (1971) Factors influencing infarct size following experimental coronary artery occlusions. Circulation 43:67–82. https://doi.org/10.1161/01.cir.43.1.67
Huikuri HV, Jokinen V, Syvanne M, Nieminen MS, Airaksinen KE, Ikaheimo MJ, Koistinen JM, Kauma H, Kesaniemi AY, Majahalme S, Niemela KO, Frick MH (1999) Heart rate variability and progression of coronary atherosclerosis. Arterioscler Thromb Vasc Biol 19:1979–1985. https://doi.org/10.1161/01.atv.19.8.1979
Heidland UE, Strauer BE (2001) Left ventricular muscle mass and elevated heart rate are associated with coronary plaque disruption. Circulation 104:1477–1482. https://doi.org/10.1161/hc3801.096325
Giannoglou GD, Chatzizisis YS, Zamboulis C, Parcharidis GE, Mikhailidis DP, Louridas GE (2008) Elevated heart rate and atherosclerosis: an overview of the pathogenetic mechanisms. Int J Cardiol 126:302–312. https://doi.org/10.1016/j.ijcard.2007.08.077
Bolli R, Fisher DJ, Entman ML (1986) Factors that determine the occurrence of arrhythmias during acute myocardial ischemia. Am Heart J 111:261–270. https://doi.org/10.1016/0002-8703(86)90138-9
Kliks BR, Burgess MJ, Abildskov JA (1975) Influence of sympathetic tone on ventricular fibrillation threshold during experimental coronary occlusion. Am J Cardiol 36:45–49. https://doi.org/10.1016/0002-9149(75)90866-8
Soyza ND, Murphy ML, Bissett JK, Kane JJ (1977) Detecting ventricular arrhythmia after myocardial infarction: comparison of Hoiter monitoring and treadmill exercise. South Med J 70:403–404. https://doi.org/10.1097/00007611-197704000-00006
Makikallio TH, Barthel P, Schneider R, Bauer A, Tapanainen JM, Tulppo MP, Schmidt G, Huikuri HV (2005) Prediction of sudden cardiac death after acute myocardial infarction: role of Holter monitoring in the modern treatment era. Eur Heart J 26:762–769. https://doi.org/10.1093/eurheartj/ehi188
van der Vleuten PA, Rasoul S, Huurnink W, van der Horst IC, Slart RH, Reiffers S, Dierckx RA, Tio RA, Ottervanger JP, De Boer MJ, Zijlstra F (2008) The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention. BMC Cardiovasc Disord 8:4. https://doi.org/10.1186/1471-2261-8-4
Lee JW, Choi E, Khanam SS, Son JW, Youn YJ, Ahn MS, Ahn SG, Kim JY, Lee SH, Yoon J, Yoo BS (2019) Prognostic value of short-term follow-up B-type natriuretic peptide levels after hospital discharge in patients with acute myocardial infarction. Int J Cardiol 289:19–23. https://doi.org/10.1016/j.ijcard.2019.01.026
Schiele F, Legalery P, Didier K, Meneveau N, Seronde MF, Caulfield F, Ducloux D, Bechetoille P, Magnin D, Faivre R, Bassand JP (2006) Impact of renal dysfunction on 1-year mortality after acute myocardial infarction. Am Heart J 151:661–667. https://doi.org/10.1016/j.ahj.2005.03.033
Shacham Y, Steinvil A, Arbel Y (2016) Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention: a multifactorial entity. J Nephrol 29:169–174. https://doi.org/10.1007/s40620-015-0255-4
Mauss O, Klingenheben T, Ptaszynski P, Hohnloser SH (2005) Bedside risk stratification after acute myocardial infarction: prospective evaluation of the use of heart rate and left ventricular function. J Electrocardiol 38:106–112. https://doi.org/10.1016/j.jelectrocard.2004.10.009
Touboul P, Andre-Fouet X, Leizorovicz A, Itti R, Lopez M, Sayegh Y, Milon H, Kirkorian G (1997) Risk stratification after myocardial infarction. A reappraisal in the era of thrombolysis. The Groupe d’Etude du Pronostic de l’Infarctus du Myocarde (GREPI). Eur Heart J 18:99–107. https://doi.org/10.1093/oxfordjournals.eurheartj.a015125
This work was supported by the basic science and frontier technology research project of Chongqing Yuzhong District Science and Technology Commission (20170404).
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
About this article
Cite this article
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. Clin Res Cardiol (2021). https://doi.org/10.1007/s00392-021-01806-1
- Mean heart rate
- Holter monitoring
- ST-segment elevation myocardial infarction
- Long-term mortality