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Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database

BACKGROUND: Low minimum heart rate (MHR) is common in critically ill myocardial infarction (MI) patients. However, the association between MHR and the mortality of critically ill MI patients remains unclear. METHODS: In this retrospective cohort study, a total of 2,031 critically ill MI patients wer...

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Autores principales: Wang, Junjie, Zhou, Lingqu, Zhang, Yinyin, Zhang, Haifeng, Xie, Yong, Chen, Zhiteng, Huang, Boshui, Zeng, Kuan, Lei, Juan, Mai, Jingting, Pan, Yue, Chen, Yangxin, Wang, Jingfeng, Guo, Qi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039698/
https://www.ncbi.nlm.nih.gov/pubmed/33850893
http://dx.doi.org/10.21037/atm-21-992
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author Wang, Junjie
Zhou, Lingqu
Zhang, Yinyin
Zhang, Haifeng
Xie, Yong
Chen, Zhiteng
Huang, Boshui
Zeng, Kuan
Lei, Juan
Mai, Jingting
Pan, Yue
Chen, Yangxin
Wang, Jingfeng
Guo, Qi
author_facet Wang, Junjie
Zhou, Lingqu
Zhang, Yinyin
Zhang, Haifeng
Xie, Yong
Chen, Zhiteng
Huang, Boshui
Zeng, Kuan
Lei, Juan
Mai, Jingting
Pan, Yue
Chen, Yangxin
Wang, Jingfeng
Guo, Qi
author_sort Wang, Junjie
collection PubMed
description BACKGROUND: Low minimum heart rate (MHR) is common in critically ill myocardial infarction (MI) patients. However, the association between MHR and the mortality of critically ill MI patients remains unclear. METHODS: In this retrospective cohort study, a total of 2,031 critically ill MI patients were enrolled from the Medical Information Mart for Intensive Care (MIMIC)-III database. Patients were divided into a low MHR group [MHR <60 beats per minute (bpm)] and a high MHR group (MHR ≥60 bpm). A Cox proportional hazard model was used to elucidate the association between these two groups and the mortality of MI patients. The association between mortality and MHR as a continuous variable was analyzed non-parametrically using restricted cubic splines. Sensitivity analyses were conducted to determine the impact of different admission heart rate, hypertension, atrial fibrillation, and vasopressor use on our results. RESULTS: MI patients in the low MHR group had higher 30-day and 1-year mortality than those in the high MHR group (20.59% vs. 10.91%, P<0.001 and 29.76% vs. 19.31%, P<0.001, respectively). After adjustment, the low MHR group was significantly correlated with 30-day mortality [hazard ratio, 1.779, 95% confidence interval (CI), 1.400–2.261, P<0.001] and 1-year mortality (hazard ratio, 1.537, 95% CI, 1.272–1.859, P<0.001). This correlation remained remarkable in patients with low or high admission heart rate, with or without hypertension, and with or without atrial fibrillation. An apparent L-curve relationship was observed between the 30-day mortality or 1-year mortality and MHR as a continuous variable. CONCLUSIONS: MHR under 60 bpm may be associated with a higher risk for both 30-day and 1-year mortality in critically ill MI patients. These findings highlight the possibility of MHR as an early risk indicator and potential therapeutic target for mortality in critically ill MI patients, which warrants further investigation.
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spelling pubmed-80396982021-04-12 Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database Wang, Junjie Zhou, Lingqu Zhang, Yinyin Zhang, Haifeng Xie, Yong Chen, Zhiteng Huang, Boshui Zeng, Kuan Lei, Juan Mai, Jingting Pan, Yue Chen, Yangxin Wang, Jingfeng Guo, Qi Ann Transl Med Original Article BACKGROUND: Low minimum heart rate (MHR) is common in critically ill myocardial infarction (MI) patients. However, the association between MHR and the mortality of critically ill MI patients remains unclear. METHODS: In this retrospective cohort study, a total of 2,031 critically ill MI patients were enrolled from the Medical Information Mart for Intensive Care (MIMIC)-III database. Patients were divided into a low MHR group [MHR <60 beats per minute (bpm)] and a high MHR group (MHR ≥60 bpm). A Cox proportional hazard model was used to elucidate the association between these two groups and the mortality of MI patients. The association between mortality and MHR as a continuous variable was analyzed non-parametrically using restricted cubic splines. Sensitivity analyses were conducted to determine the impact of different admission heart rate, hypertension, atrial fibrillation, and vasopressor use on our results. RESULTS: MI patients in the low MHR group had higher 30-day and 1-year mortality than those in the high MHR group (20.59% vs. 10.91%, P<0.001 and 29.76% vs. 19.31%, P<0.001, respectively). After adjustment, the low MHR group was significantly correlated with 30-day mortality [hazard ratio, 1.779, 95% confidence interval (CI), 1.400–2.261, P<0.001] and 1-year mortality (hazard ratio, 1.537, 95% CI, 1.272–1.859, P<0.001). This correlation remained remarkable in patients with low or high admission heart rate, with or without hypertension, and with or without atrial fibrillation. An apparent L-curve relationship was observed between the 30-day mortality or 1-year mortality and MHR as a continuous variable. CONCLUSIONS: MHR under 60 bpm may be associated with a higher risk for both 30-day and 1-year mortality in critically ill MI patients. These findings highlight the possibility of MHR as an early risk indicator and potential therapeutic target for mortality in critically ill MI patients, which warrants further investigation. AME Publishing Company 2021-03 /pmc/articles/PMC8039698/ /pubmed/33850893 http://dx.doi.org/10.21037/atm-21-992 Text en 2021 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Wang, Junjie
Zhou, Lingqu
Zhang, Yinyin
Zhang, Haifeng
Xie, Yong
Chen, Zhiteng
Huang, Boshui
Zeng, Kuan
Lei, Juan
Mai, Jingting
Pan, Yue
Chen, Yangxin
Wang, Jingfeng
Guo, Qi
Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database
title Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database
title_full Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database
title_fullStr Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database
title_full_unstemmed Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database
title_short Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database
title_sort minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the mimic-iii database
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039698/
https://www.ncbi.nlm.nih.gov/pubmed/33850893
http://dx.doi.org/10.21037/atm-21-992
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