The impact of pre-procedure heart rate on adverse clinical outcomes in patients undergoing percutaneous coronary intervention: Results from a 2-year follow-up of the GLOBAL LEADERS trial.

Wang, Rutao; Takahashi, Kuniaki; Chichareon, Ply; Gao, Chao; Kogame, Norihiro; Modolo, Rodrigo; Tomaniak, Mariusz; Kawashima, Hideyuki; Ono, Masafumi; Hara, Hironori; Schächinger, Volker; Tonev, Gincho; Ungi, Imre; Botelho, Roberto; Eeckhout, Eric; Hamm, Christian; Jüni, Peter; Vranckx, Pascal; Windecker, Stephan; Garg, Scot; ... (2020). The impact of pre-procedure heart rate on adverse clinical outcomes in patients undergoing percutaneous coronary intervention: Results from a 2-year follow-up of the GLOBAL LEADERS trial. Atherosclerosis, 303, pp. 1-7. Elsevier 10.1016/j.atherosclerosis.2020.04.010

Text The impact of pre-procedure heart rate on adverse clinical outcomes in patients undergoing percutaneous coronary intervention.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (1MB) | Request a copy

BACKGROUND AND AIMS

The prognostic impact of pre-procedure heart rate (PHR) following percutaneous coronary intervention (PCI) has not yet been fully investigated. This post-hoc analysis sought to assess the impact of PHR on medium-term outcomes among patients having PCI, who were enrolled in the "all-comers" GLOBAL LEADERS trial.

METHODS AND RESULTS

The primary endpoint (composite of all-cause death or new Q-wave myocardial infarction [MI]) and key secondary safety endpoint (bleeding according to Bleeding Academic Research Consortium [BARC] type 3 or 5) were assessed at 2 years. PHR was available in 15,855 patients, and when evaluated as a continuous variable (5 bpm increase) and following adjustment using multivariate Cox regression, it significantly correlated with the primary endpoint (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03-1.09, p < 0.001). Using dichotomous cut-off criteria, a PHR>67 bpm was associated with increased all-cause mortality (HR 1.38, 95%CI 1.13-1.69, p = 0.002) and more frequent new Q-wave MI (HR 1.41, 95%CI 1.02-1.93, p = 0.037). No significant association was found between PHR and BARC 3 or 5 bleeding (HR 1.04, 95% CI 0.99-1.09, p = 0.099). There was no interaction with the primary (p-inter = 0.236) or secondary endpoint (p-inter = 0.154) when high and low PHR was analyzed according to different antiplatelet strategies.

CONCLUSIONS

Elevated PHR was an independent predictor of all-cause mortality at 2 years following PCI in the "all-comer" GLOBAL LEADERS trial. The prognostic value of increased PHR on outcomes was not affected by the different antiplatelet strategies in this trial.

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