University of Massachusetts Medical School Faculty Publications

Title

Heart rate is a prognostic risk factor for myocardial infarction: a post hoc analysis in the PERFORM (Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic attack) study population

UMMS Affiliation

Department of Neurology

Date

10-9-2013

Document Type

Article

Medical Subject Headings

Aged; Female; Heart Rate; Humans; Ischemic Attack, Transient; Male; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Naphthalenes; Prognosis; Propionates; Risk Factors; Stroke

Disciplines

Cardiology | Cardiovascular Diseases | Neurology

Abstract

BACKGROUND: Elevated resting heart rate is known to be detrimental to morbidity and mortality in cardiovascular disease, though its effect in patients with ischemic stroke is unclear. We analyzed the effect of baseline resting heart rate on myocardial infarction (MI) in patients with a recent noncardioembolic cerebral ischemic event participating in PERFORM.

METHODS: We compared fatal or nonfatal MI using adjusted Cox proportional hazards models for PERFORM patients with baseline heart rate < 70 bpm (n=8178) or > /=70 bpm (n=10,802). In addition, heart rate was analyzed as a continuous variable. Other cerebrovascular and cardiovascular outcomes were also explored.

RESULTS: Heart rate > /=70 bpm was associated with increased relative risk for fatal or nonfatal MI (HR 1.32, 95% CI 1.03-1.69, P=0.029). For every 5-bpm increase in heart rate, there was an increase in relative risk for fatal and nonfatal MI (11.3%, P=0.0002). Heart rate > /=70 bpm was also associated with increased relative risk for a composite of fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (excluding hemorrhagic death) (P < 0001); vascular death (P < 0001); all-cause mortality (P < 0001); and fatal or nonfatal stroke (P=0.04). For every 5-bpm increase in heart rate, there were increases in relative risk for fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (4.7%, P < 0.0001), vascular death (11.0%, P < 0.0001), all-cause mortality (8.0%, P < 0.0001), and fatal and nonfatal stroke (2.4%, P=0.057).

CONCLUSION: Elevated heart rate > /=70 bpm places patients with a noncardioembolic cerebral ischemic event at increased risk for MI.

Rights and Permissions

Citation: Int J Cardiol. 2013 Oct 9;168(4):3500-5. doi: 10.1016/j.ijcard.2013.04.206. Epub 2013 May 22.Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID

23706327