Association between preoperative ambulatory heart rate and postoperative myocardial injury: a retrospective cohort study.
Br J Anaesth
; 121(4): 722-729, 2018 Oct.
Article
em En
| MEDLINE
| ID: mdl-30236234
ABSTRACT
BACKGROUND:
Resting heart rate is well established as a predictor of morbidity and mortality in the general population. However, the relationship between preoperative heart rate and perioperative outcomes, specifically myocardial injury, is unclear.METHODS:
This retrospective cohort study included patients undergoing elective major non-cardiac surgery from 2008 to 2014 at a multisite healthcare system. The exposure was ambulatory heart rate measured during the outpatient preoperative clinic visit, whereas the outcome of interest was myocardial injury (peak postoperative troponin I concentration >30 ng L-1). Covariates included patient characteristics, comorbidities, and preoperative medications. We constructed several multivariable regression models that each modelled heart rate in a different manner, including as a simple continuous variable, categories, and fractional polynomials.RESULTS:
The cohort included 41 140 patients, of whom 4857 (11.8%) experienced myocardial injury. Based on pre-specified heart categories thresholds, a heart rate ≥90 beats min-1 was associated with an elevated odds of myocardial injury compared with a heart rate <60 beats min-1 (adjusted odds ratio, 1.22; 95% confidence interval, 1.06-1.39; P=0.005). This result was consistent regardless of the method used for categorisation. When fractional polynomials were used to model heart rate, a 'J-shaped' relationship between heart rate and odds of myocardial injury was observed.CONCLUSIONS:
This cohort study found that both very high preoperative heart rates, and possibly also very low heart rates, are associated with increased risk of myocardial injury. Whether heart rate is a modifiable risk factor, or rather simply a marker of underlying cardiac pathology, needs to be determined in further research.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Frequência Cardíaca
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Cardiomiopatias
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Br J Anaesth
Ano de publicação:
2018
Tipo de documento:
Article