1. Usefulness of Discharge Resting Heart Rate to Predict Adverse Cardiovascular Outcomes in Patients With Left Main Coronary Artery Disease Revascularized With Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting (from the EXCEL Trial)
- Author
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Bernard J. Gersh, Ioanna Kosmidou, Aaron Crowley, Joseph F. Sabik, Piet W. Boonstra, Gregg W. Stone, Patrick W. Serruys, Ori Ben-Yehuda, Leon G. Dos Reis Macedo, Arie Pieter Kappetein, and Cardiothoracic Surgery
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Bypass grafting ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Revascularization ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Postoperative Complications ,Heart Rate ,Risk Factors ,Internal medicine ,medicine ,Humans ,Sinus rhythm ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Aged ,Netherlands ,business.industry ,Incidence ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,Patient Discharge ,United Kingdom ,United States ,Survival Rate ,surgical procedures, operative ,medicine.anatomical_structure ,Treatment Outcome ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery ,Follow-Up Studies - Abstract
The prognostic impact of resting heart rate (RHR) following revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD) is unknown. We aimed to assess the effect of RHR at discharge on 3-year cardiovascular outcomes following PCI and CABG for LMCAD. In the EXCEL trial, 1,905 patients with LMCAD were randomized to PCI with everolimus-eluting stents versus CABG. RHR was measured at discharge following the index hospitalization. The principal outcome measure was the composite endpoint of death, myocardial infarction (MI) or stroke at 3 years. Among 1,303 patients in sinus rhythm with available ECGs, the median (IQR) discharge RHR was 72 (62to 81) bpm. Median discharge RHR was higher after CABG versus PCI (78 [IQR 70 to 86] versus 65 [IQR 59 to 74] bpm, p0.0001). At 3 years, 107 patients (8.2%) had a primary composite endpoint event including 61 patients (4.7%) who died. By multivariable analysis, discharge RHR assessed as a continuous variable (per 5 bpm) was an independent predictor at 3 years of the primary composite endpoint of death, MI, or stroke (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.06 to 1.25, p = 0.0006); the secondary composite endpoint of death, MI, stroke, or ischemia-driven revascularization at 3 years (HR 1.12, 95% CI 1.05 to 1.19, p = 0.0007); all-cause mortality (HR 1.18, 95% CI 1.07 to 1.31, p = 0.002); and cardiovascular death (HR 1.16, 95% CI 1.00 to 1.33, p = 0.046). No significant interactions were present between RHR and treatment with PCI versus CABG for the primary (p
- Published
- 2020
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