Prognostic Value of Resting Heart Rate in a Broad Population of Patients With Stable Coronary Artery Disease: Prospective Single-Center Cohort Study

Introductions and objectivesOur aim was to investigate the prognostic value of the resting heart rate (RHR) in a broad unselected population of patients with stable coronary artery disease (sCAD).MethodBetween February 1, 2000 and January 31, 2004, 1264 ambulatory patients with sCAD were recruited into the prospective study. Patients were followed up for major events (i.e. death, acute coronary syndrome, coronary revascularization, stroke, and hospitalization for heart failure). Associations between these events and the RHR (i.e. ≥70 beats per minute [bpm] versus <70 bpm) were evaluated.ResultsThe patients’ median age was 68 years (interquartile range [IQR] 60–74 years) and 926 (73%) were male. The RHR was ≥70 bpm in 645 patients (51%) and <70 bpm in 619 (49%). After a median follow-up period of 25 months (IQR 12–39 months), with only seven patients lost to follow-up, the probability of an event was 17.48% in patients with an RHR ≥70 bpm and 17.67% in those with an RHR <70 bpm (P=.32) and total mortality was 2.32% and 2.5%, respectively (P=.56). After adjustment for age, sex, cardiovascular risk factors, blood pressure, baseline cardiac rhythm, ejection fraction and treatment at first visit, no significant association was found between the RHR and major events (hazard ratio [HR]=1.04; 95% confidence interval [CI], 0.76–1.43; P=.79) or mortality (HR=1.24; 95% CI, 0.55–2.81; P=.61).ConclusionsThe RHR was not an adverse prognostic factor in this group of unselected patients with sCAD. The prognostic value of the RHR in daily clinical practice could be low in this population.

Introducción y objetivosNuestro objetivo es evaluar el valor pronóstico de la frecuencia cardiaca en reposo (FCr) en una población general no seleccionada de pacientes con cardiopatía isquémica crónica (CIC).MétodosDel 1 de febrero de 2000 al 31 de enero de 2004, se incluyó prospectivamente a 1.264 pacientes ambulatorios con CIC, y se los siguió para eventos mayores (mortalidad, síndrome coronario agudo, revascularización coronaria, ictus e ingreso por insuficiencia cardiaca) para evaluar la asociación de éstos con la FCr (≥ 70 frente a < 70 lat/min).ResultadosLa mediana [p25–p75] de edad fue 68 [60–74] años, y 926 pacientes eran varones (73%); 645 pacientes (51%) presentaron una FCr ≥ 70 lat/min y 619 (49%), FCr < 70 lat/min. Tras una mediana de seguimiento de 25 [12–39] meses, con sólo 7 pacientes perdidos, la probabilidad de eventos fue del 17,48% en pacientes con FCr ≥ 70 lat/min y del 17,67% en pacientes con FCr < 70 lat/min (p = 0,32) y la mortalidad total, del 2,32 y el 2,5% respectivamente (p = 0,56). Tras ajustar por edad, sexo, factores de riesgo cardiovascular, presión arterial, ritmo basal, fracción de eyección y tratamiento en la primera visita, no encontramos asociación entre la FCr y la tasa de eventos mayores (hazard ratio [HR] = 1,04; intervalo de confianza [IC] del 95%, 0,76–1,43; p = 0,79) o la mortalidad total (HR = 1,24; IC del 95%, 0,55–2,81; p = 0,61).ConclusionesLa FCr no ha sido un factor pronóstico adverso en esta muestra no seleccionada de pacientes con CIC. La importancia pronóstica de la FCr en la práctica clínica habitual podría ser baja en esta población.