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

Fox, K., Bousser, M., Amarenco, P., Chamorro, A., Fisher, M., Ford, I. , Hennerici, M.G., Mattle, H.P. and Rothwell, P.M. (2013) 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. International Journal of Cardiology, 168(4), pp. 3500-3505. (doi:10.1016/j.ijcard.2013.04.206)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Ford, Professor Ian
Authors: Fox, K., Bousser, M., Amarenco, P., Chamorro, A., Fisher, M., Ford, I., Hennerici, M.G., Mattle, H.P., and Rothwell, P.M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:International Journal of Cardiology
Publisher:Elsevier
ISSN:0167-5273
ISSN (Online):1874-1754

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