Does heart rate variability correlate with long-term prognosis in myocardial infarction patients treated by early revascularization?
AIM To assess the prevalence of depressed heart rate variability(HRV) after an acute myocardial infarction(MI),and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODS Time-domain HRV(obtained from 24-h Holter recordings) was assessed in 326 patients(63.5 ± 12....
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Veröffentlicht in: | World journal of cardiology 2017-01, Vol.9 (1), p.27-38 |
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Zusammenfassung: | AIM To assess the prevalence of depressed heart rate variability(HRV) after an acute myocardial infarction(MI),and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODS Time-domain HRV(obtained from 24-h Holter recordings) was assessed in 326 patients(63.5 ± 12.1 years old; 80% males),two weeks after a complicated MI treated by early reperfusion: 208 ST-elevation myocardial infarction(STEMI) patients(in which reperfusion wassuccessfully obtained within 6 h of symptoms in 94% of cases) and 118 non-ST-elevation myocardial infarction(NSTEMI) patients(percutaneous coronary intervention was performed within 24 h and successful in 73% of cases). Follow-up of the patients was performed via telephone interviews a median of 25 mo after the index event(95%CI of the mean 23.3-28.0). Primary endpoint was occurrence of all-cause or cardiac death; secondary end-point was occurrence of major clinical events(MCE,defined as mortality or readmission for new MI,new revascularization,episodes of heart failure or stroke). Possible correlations between HRV parameters(mainly the standard deviation of all normal RR intervals,SDNN),clinical features(age,sex,type of MI,history of diabetes,left ventricle ejection fraction),angiographic characteristics(number of coronary arteries with critical stenoses,success and completeness of revascularization) and long-term outcomes were analysed.RESULTS Markedly depressed HRV parameters were present in a relatively small percentage of patients: SDNN < 70 ms was found in 16% and SDNN < 50 ms in 4% of cases. No significant differences were present between STEMI and NSTEMI cases as regards to their distribution among quartiles of SDNN(χ~2 =1.536,P = 0.674). Female sex and history of diabetes maintained a significant correlation with lower values of SDNN at multivariate Cox regression analysis(respectively: P = 0.008 and P = 0.008),while no correlation was found between depressed SDNN and history of previous MI(P = 0.999) or number of diseased coronary arteries(P = 0.428) or unsuccessful percutaneous coronary intervention(PCI)(P = 0.691). Patients with left ventricle ejection fraction(LVEF) < 40% presented more often SDNN values in the lowest quartile(P < 0.001). After > 2 years from infarction,a total of 10 patients(3.1%) were lost to follow-up. Overall incidence of MCE at follow-up was similar between STEMI and NSTEMI(P = 0.141),although all-cause and cardiac mortality were higher among NSTEMI |
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ISSN: | 1949-8462 1949-8462 |
DOI: | 10.4330/wjc.v9.i1.27 |