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. 2020 Jun:303:1-7.
doi: 10.1016/j.atherosclerosis.2020.04.010. Epub 2020 Apr 28.

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

Rutao Wang  1 , Kuniaki Takahashi  2 , Ply Chichareon  3 , Chao Gao  1 , Norihiro Kogame  2 , Rodrigo Modolo  4 , Mariusz Tomaniak  5 , Hideyuki Kawashima  6 , Masafumi Ono  6 , Hironori Hara  6 , Volker Schächinger  7 , Gincho Tonev  8 , Imre Ungi  9 , Roberto Botelho  10 , Eric Eeckhout  11 , Christian Hamm  12 , Peter Jüni  13 , Pascal Vranckx  14 , Stephan Windecker  15 , Scot Garg  16 , Robert Jan Van Geuns  17 , Yoshinobu Onuma  18 , Patrick W Serruys  19
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Free article

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

Rutao Wang et al. Atherosclerosis. 2020 Jun.
Free article

Abstract

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.

Keywords: Coronary artery disease; Mortality; Percutaneous coronary intervention; Pre-procedure heart rate; Predictor.

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Conflict of interest statement

Declaration of competing interest Dr. Chichareon reports research grant from Biosensors, outside the submitted work. Dr. Modolo received research grant form Biosensors and SMT. Dr. Eeckhout reports research grant from Biosensors. Dr. Hamm received advisory board fees from AstraZeneca. Dr. Jüni received grants from Canadian Institutes of Health Research (CIHR), during the conduct of the study, grants from Astra Zeneca, grants from Biotronik, grants from Biosensors International, grants from Eli Lilly, grants from The Medicines Company, outside the submitted work; and Peter Jüni serves as unpaid member of the steering group of trials funded by Astra Zeneca, Biotronik, Biosensors, St. Jude Medical and The Medicines Company. Dr. Vranckx received personal fees from Astra Zeneca, personal fees from Bayer Health Care, personal fees from Daiichi Sankio, personal fees from Terumo, personal fees from CLS Behring, outside the submitted work. Dr. Windecker reports research and educational grants to the institution from Amgen, Abbott, Biotronik, Boston Scientific, Bayer, BMS, CSL Behring, Edwards Lifesciences, Medtronic, Polares and Sinomed. Dr. van Geuns received speakers fee from Abbott Vascular and Boston Scientific. Dr. Serruys reports personal fees from Biosensors, personal fees from Cardialysis, personal fees from Medtronic, personal fees from Micel Technologies, personal fees from Sinomedical Sciences Technology, personal fees from Philips/Volcano, personal fees from Xeltis, personal fees from HeartFlow, outside the submitted work.

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