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• W2009394597 abstract "Heart rate (HR) predicts mortality and cardiovascular events in the general population and in patients with coronary artery disease. However, little evidence is available for patients after coronary revascularization. The aim of this study was to assess the prognostic value of ambulatory postoperative HR after coronary artery bypass grafting. Data from a prospective cohort study enrolling patients who underwent nonurgent coronary artery bypass grafting from 1998 to 2002 were analyzed. Baseline postoperative HR was measured 2 months after surgery, and patients were followed annually thereafter. The primary outcome was all-cause mortality. The secondary outcome combined any of the following events: death, nonfatal acute coronary syndromes, stroke or transient ischemic attack, secondary coronary revascularization, or vascular surgery. Seven hundred ninety-four patients (mean age 65.8 ± 9.3 years) were eligible for follow-up, predominantly men (84.1%). The mean follow-up duration was 3.2 ± 1.3 years, during which 40 patients (5.0%) died. In the univariate analysis, HR >90 beats/min was significantly associated with all outcomes. After adjustments for major confounding factors and the use of β blockers, postoperative HR >90 beats/min remained significantly associated with the secondary outcome (hazard ratio 2.26, 95% confidence interval 1.04 to 4.91, p = 0.04). Association of postoperative HR >90 beats/min with all-cause mortality was only borderline in the multivariate analysis (hazard ratio 3.57, 95% confidence interval 0.90 to 14.17, p = 0.07), because of the limited sample population size. In conclusion, postoperative HR >90 beats/min may be associated with poor prognoses in patients with coronary artery disease, even after surgical revascularization. Heart rate (HR) predicts mortality and cardiovascular events in the general population and in patients with coronary artery disease. However, little evidence is available for patients after coronary revascularization. The aim of this study was to assess the prognostic value of ambulatory postoperative HR after coronary artery bypass grafting. Data from a prospective cohort study enrolling patients who underwent nonurgent coronary artery bypass grafting from 1998 to 2002 were analyzed. Baseline postoperative HR was measured 2 months after surgery, and patients were followed annually thereafter. The primary outcome was all-cause mortality. The secondary outcome combined any of the following events: death, nonfatal acute coronary syndromes, stroke or transient ischemic attack, secondary coronary revascularization, or vascular surgery. Seven hundred ninety-four patients (mean age 65.8 ± 9.3 years) were eligible for follow-up, predominantly men (84.1%). The mean follow-up duration was 3.2 ± 1.3 years, during which 40 patients (5.0%) died. In the univariate analysis, HR >90 beats/min was significantly associated with all outcomes. After adjustments for major confounding factors and the use of β blockers, postoperative HR >90 beats/min remained significantly associated with the secondary outcome (hazard ratio 2.26, 95% confidence interval 1.04 to 4.91, p = 0.04). Association of postoperative HR >90 beats/min with all-cause mortality was only borderline in the multivariate analysis (hazard ratio 3.57, 95% confidence interval 0.90 to 14.17, p = 0.07), because of the limited sample population size. In conclusion, postoperative HR >90 beats/min may be associated with poor prognoses in patients with coronary artery disease, even after surgical revascularization. Heart rate (HR) is a prognostic marker in patients with coronary artery disease.1Diaz A. Bourassa M.G. Guertin M.C. Tardif J.C. Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease.Eur Heart J. 2005; 26: 967-974Crossref PubMed Scopus (692) Google Scholar, 2Mauss O. Klingenheben T. Ptaszynski P. Hohnloser S.H. Bedside risk stratification after acute myocardial infarction: prospective evaluation of the use of heart rate and left ventricular function.J Electrocardiol. 2005; 38: 106-112Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 3Eagle K.A. Lim M.J. Dabbous O.H. Pieper K.S. Goldberg R.J. Van de Werf F. Goodman S.G. Granger C.B. Steg P.G. Gore J.M. Budaj A. Avezum A. Flather M.D. Fox K.A. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry.JAMA. 2004; 291: 2727-2733Crossref PubMed Scopus (1208) Google Scholar However, unlike in patients with medically treated coronary artery disease, the prognostic value of HR after surgical coronary revascularization has been poorly studied. Recently, we showed that preoperative HR is predictive of cardiovascular events within 30 days after coronary artery bypass grafting (CABG).4Aboyans V. Frank M. Nubret K. Lacroix P. Laskar M. Heart rate and pulse pressure at rest are major prognostic markers of early postoperative complications after coronary bypass surgery.Eur J Cardiothorac Surg. 2008; 33: 971-976Crossref PubMed Scopus (24) Google Scholar Because CABG has been shown to be beneficial to patients with ischemic heart disease,5Peduzzi P. Kamina A. Detre K. Twenty-two-year follow-up in the VA Cooperative Study of Coronary Artery Bypass Surgery for Stable Angina.Am J Cardiol. 1998; 81: 1393-1399Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar, 6Myers W.O. Blackstone E.H. Davis K. Foster E.D. Kaiser G.C. CASS Registry long term surgical survival.J Am Coll Cardiol. 1999; 33: 488-498Abstract Full Text Full Text PDF PubMed Scopus (138) Google Scholar especially in terms of mortality reduction, it seemed of interest to further assess the prognostic significance of HR in this specific subset of patients. We therefore focused this study on postoperative HR at rest and long-term outcomes after CABG. We hypothesized that higher HR at rest measured 2 months after CABG during a postoperative surgical outpatient visit would be significantly associated with further cardiovascular events during follow-up.MethodsThis observational cohort study was designed for the risk prediction of perioperative and postoperative events after CABG. Data collection and variables definition have been described in detail elsewhere.7Aboyans V. Guilloux J. Lacroix P. Yildiz C. Postil A. Laskar M. Common carotid intima-media thickness measurement is not a pertinent predictor for secondary cardiovascular events after coronary bypass surgery A prospective study.Eur J Cardiothorac Surg. 2005; 28: 415-419Crossref PubMed Scopus (12) Google Scholar, 8Aboyans V. Lacroix P. Postil A. Guilloux J. Rolle F. Cornu E. Laskar M. Subclinical peripheral arterial disease and incompressible ankle arteries are both long-term prognostic factors in patients undergoing coronary artery bypass grafting.J Am Coll Cardiol. 2005; 46: 815-820Abstract Full Text Full Text PDF PubMed Scopus (91) Google ScholarBriefly, we included all patients referred to our department for CABG from September 1998 to August 2002 in a prospective longitudinal cohort study.Clinical recording began approximately 1 month before surgery in case of nonurgent CABG, during the anesthetist outpatient visit, and was continued during hospitalization. Clinical features and patients' medical histories were recorded as follows: gender, age, and history of coronary artery disease, cardiac surgery, stroke or transient ischemic attack. The following cardiovascular risk factors were noted: smoking, defined by active smoking or discontinuation <2 years before CABG; diabetes mellitus, if fasting glucose was >7.0 mmol/L9Diagnosis and classification of diabetes mellitus.Diabetes Care. 2010; 33: S62-S69PubMed Google Scholar or in case of ongoing oral antidiabetic and/or insulin therapy; hypertension, when elevated blood pressure was reported in the medical chart and/or in case of ongoing antihypertensive therapy; dyslipidemia, defined either by fasting blood cholesterol level on admission >240 mg/dl, low-density lipoprotein cholesterol level >160 mg/dl,10Jellinger P.S. Dickey R.A. Ganda O.P. Mehta A.E. Nguyen T.T. Rodbard H.W. Seibel J.A. Shepherd M.D. Smith D.A. AACE medical guidelines for clinical practice for the diagnosis and treatment of dyslipidemia and prevention of atherogenesis.Endocr Pract. 2000; 6: 162-213PubMed Google Scholar or the use of lipid-lowering medication before surgery. Overweight was defined by a body mass index >30 kg/m2. Peripheral arterial disease was defined by any history of clinical disease, or by an abnormal ankle brachial index (<0.85 or >1.50). Symptomatic heart failure was diagnosed clinically according to the New York Heart Association classification. HR was measured on admission and during the first postoperative outpatient visit (baseline measurement) on an electrocardiogram recorded in the supine position after a 5-minute rest. In case of sinus rhythm or pacing, HR was measured on 3 cardiac cycles. In patients with arrhythmia, it was measured over a 6-second period, to minimize the risk for HR overestimation to 2 beats/min.11Atwood J.E. Myers J. Sandhu S. Lachterman B. Friis R. Oshita A. Forbes S. Walsh D. Froelicher V. Optimal sampling interval to estimate heart rate at rest and during exercise in atrial fibrillation.Am J Cardiol. 1989; 63: 45-48Abstract Full Text PDF PubMed Scopus (36) Google ScholarThe left ventricular ejection fraction was determined by preoperative ventriculography and considered altered when <0.40. Coronary artery stenosis was considered significant when >70% diameter reduction or >50% for the left main coronary artery.Ongoing therapies at first postoperative visit were recorded, especially HR-lowering drugs (β blockers or nondihydropyridine calcium channel blockers), as well as statins, angiotensin-converting enzyme inhibitors, and angiotensin antagonists.For every patient, we collected information on the number of bypasses and anastomoses and the use of an on-pump or off-pump technique. Revascularization was considered complete if all diseased coronary arteries were bypassed. Urgent CABG was defined by symptomatic left main coronary artery stenosis, refractory angina pectoris, or an unstable hemodynamic condition.All patients were systematically scheduled for a first postoperative visit between the second and third months after surgery. For each patient, electrocardiography was performed for postoperative rest HR determination. Thereafter, annual visits were scheduled. Patients who did not meet their appointments were contacted by telephone. In case of death or patients' not returning calls, family physicians were contacted for information. Hospital records were screened for patients with suspected cardiovascular events and in case of in-hospital death.The primary outcome in our study was all-cause mortality. The secondary outcome was composite, combining any of the following events, whichever occurring first: death, secondary coronary revascularization, nonfatal acute coronary syndromes, nonfatal stroke or transient ischemic attack, and vascular surgery.Continuous variables are reported as mean ± SD and categorical variables as numbers and percentages. All data collected before surgery, including HR, were included in a univariate analysis model. Univariate analysis used Kaplan-Meier survival curves with log-rank tests. Independent predictors of survival were calculated using a Cox regression model, using a backward stepwise procedure. A p value <0.05 was considered to indicate statistical significance. Analyses were performed using StatView version 5.0 (SAS Institute Inc., Cary, North Carolina).ResultsAmong the 1,022 patients enrolled, 32 died during the first month after CABG and were thus excluded from this analysis. Thirty-five additional patients were excluded because of missing data regarding preoperative (n = 5) and postoperative (n = 30) HR. Among the remaining 955 patients, 161 underwent concomitant valvular and/or vascular surgery and were thus excluded from statistical analysis. The baseline characteristics of the remaining 794 patients are listed in Table 1. Mean preoperative and 2-month postoperative ambulatory baseline HRs at rest were 64.2 ± 13.0 and 67.4 ± 12.6 beats/min, respectively. The overall distribution of HR measured during the postoperative visit is displayed in Figure 1. The preoperative and postoperative HRs were found to be correlated (Figure 2), although important disparities were apparent in many cases.Table 1Baseline characteristics (n = 794)VariableValuePreoperative data Age (years)65.8 ± 9.3 Women126 (15.9%) Smokers240 (30.3%) Hypercholesterolemia⁎Defined by fasting blood cholesterol level on admission >240 mg/dl, low-density lipoprotein cholesterol level >160 mg/dl,10 or the use of lipid-lowering medication before surgery.468 (59.2%) Hypertension†Defined by history of elevated blood pressure in the medical chart and/or ongoing antihypertensive therapy.385 (48.6%) Diabetes mellitus203 (25.7%) BMI (kg/m2)27.3 ± 12.7 Pulmonary disease120 (15.3%)NYHA class I463 (58.4%) II249 (31.4%) III70 (8.7%) IV12 (1.5%)Supraventricular arrhythmia49 (6.2%)Ejection fraction <0.4069 (8.7%)Redo coronary surgery31 (3.9%)Left main coronary artery stenosis >50%136 (17.2%)Triple-vessel coronary disease546 (68.9%)Unstable cardiac status128 (16.2%)Peripheral arterial disease287 (36.2%)Cerebrovascular disease82 (10.3%)Operative data Off-pump surgery128 (16.1%) Number of coronary anastomotic sites3.1 ± 0.9 Complete revascularization678 (85.4%)Drug therapy at postoperative visit β blockers604 (76.1%) Dihydropyridines96 (12.1%) ACE inhibitors/angiotensin antagonists260 (32.8%) Statins545 (68.6%)Data are expressed as mean ± SD or as number (percentage).ACE = angiotensin-converting enzyme; BMI = body mass index; NYHA = New York Heart Association. Defined by fasting blood cholesterol level on admission >240 mg/dl, low-density lipoprotein cholesterol level >160 mg/dl,10Jellinger P.S. Dickey R.A. Ganda O.P. Mehta A.E. Nguyen T.T. Rodbard H.W. Seibel J.A. Shepherd M.D. Smith D.A. AACE medical guidelines for clinical practice for the diagnosis and treatment of dyslipidemia and prevention of atherogenesis.Endocr Pract. 2000; 6: 162-213PubMed Google Scholar or the use of lipid-lowering medication before surgery.† Defined by history of elevated blood pressure in the medical chart and/or ongoing antihypertensive therapy. Open table in a new tab Figure 2Correlation between preoperative and postoperative HR at rest. adm = admission; fu = follow-up.View Large Image Figure ViewerDownload Hi-res image Download (PPT)During the mean follow-up period of 3.2 ± 1.3 years, 40 patients (5.0%) died, 15 (1.9%) of cardiovascular causes. Acute coronary syndromes occurred in 27 patients (3.4%), and 24 (3.0%) patients underwent redo coronary revascularization. Fourteen patients (1.8%) experienced strokes or transient ischemic attacks, and 34 patients (4.3%) required additional vascular surgery. Altogether, the secondary outcome occurred in 98 patients (12.3%). Patients with postoperative rest HRs ≥90 beats/min were at greater risk for death (Figure 3) and at greater risk for the occurrence of the secondary outcome (Figure 3), starting at 75 beats/min. The association between postoperative HR and mortality is listed in Table 2. Compared with postoperative HR <60 beats/min, HR >90 beats/min was associated with increased risk for mortality after multiple adjustments. However, when fully adjusted to confounding factors, this association did not remain significant.Figure 3Kaplan-Meier survival curves with number of subjects at risk by HR categories, with respect to the primary (A) and secondary composite (B) end points (p values unadjusted).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Table 2Association between postoperative heart rate at rest and the primary outcome, all-cause mortalityVariableUnadjustedModel 1⁎Adjusted for age, gender, β blockers, and dihydropyridines.Model 2†Model 1 plus smoking, hypertension, hypercholesterolemia, diabetes mellitus, and body mass index.Model 3‡Model 2 plus triple-vessel disease, New York Heart Association class III or IV, left ventricular ejection fraction <0.40, redo surgery, supraventricular arrhythmia, pulmonary disease, peripheral artery disease, cerebrovascular disease, and unstable cardiac status.Model 4§Model 3 plus off-pump surgery, complete revascularization, statins, and angiotensin-converting enzyme inhibitors or angiotensin antagonists.HR (beats/min) <60ReferenceReferenceReferenceReferenceReference 60–742.05 (0.81–5.16)1.80 (0.71–4.61)2.62 (0.87–7.92)2.56 (0.84–7.81)2.63 (0.85–8.18)p = 0.12p = 0.21p = 0.09p = 0.10p = 0.10 75–892.19 (0.78–6.15)1.87 (0.65–5.32)2.75 (0.83–9.10)2.64 (0.79–8.87)2.50 (0.73–8.53)p = 0.14p = 0.24p = 0.10p = 0.21p = 0.15 ≥905.06 (1.70–15.10)3.15 (0.97–10.17)4.08 (1.06–15.67)4.16 (1.07–16.23)3.57 (0.90–14.17)p = 0.004p = 0.055p = 0.04p = 0.04p = 0.07Data are expressed as hazard ratio (95% confidence interval). Adjusted for age, gender, β blockers, and dihydropyridines.† Model 1 plus smoking, hypertension, hypercholesterolemia, diabetes mellitus, and body mass index.‡ Model 2 plus triple-vessel disease, New York Heart Association class III or IV, left ventricular ejection fraction <0.40, redo surgery, supraventricular arrhythmia, pulmonary disease, peripheral artery disease, cerebrovascular disease, and unstable cardiac status.§ Model 3 plus off-pump surgery, complete revascularization, statins, and angiotensin-converting enzyme inhibitors or angiotensin antagonists. Open table in a new tab Regarding the association of HR with the composite secondary outcome (Table 3), we found a persistent association for HR >90 beats/min, even after adjustments. Higher HR categories starting from 75 beats/min showed only a trend for risk increase in the multivariate analysis models. We did not find any significant association between preoperative HR and long-term outcomes during follow-up (data not shown).Table 3Association between postoperative heart rate at rest and the composite secondary outcome (death, secondary coronary revascularization, nonfatal acute coronary syndromes, nonfatal stroke or transient ischemic attack, and vascular surgery)VariableUnadjustedModel 1⁎Adjusted for age, gender, β blockers, and dihydropyridines.Model 2†Model 1 plus smoking, hypertension, hypercholesterolemia, diabetes mellitus, and body mass index.Model 3‡Model 2 plus triple-vessel disease, New York Heart Association class III or IV, left ventricular ejection fraction <0.40, redo surgery, supraventricular arrhythmia, pulmonary disease, peripheral artery disease, cerebrovascular disease, and unstable cardiac status.Model 4§Model 3 plus off-pump surgery, complete revascularization, statins, and angiotensin-converting enzyme inhibitors or angiotensin antagonists.Heart rate (beats/min) <60ReferenceReferenceReferenceReferenceReference 60–741.21 (0.70–2.09)1.20 (0.69–2.08)1.14 (0.65–2.02)1.08 (0.60–1.92)1.06 (0.59–1.90)p = 0.49p = 0.51p = 0.65p = 0.80p = 0.84 75–891.91 (1.07–3.43)1.93 (1.07–3.48)1.91 (1.05–3.50)1.67 (0.90–3.10)1.69 (0.91–3.14)p = 0.03p = 0.03p = 0.04p = 0.10p = 0.10 ≥903.41 (1.75–6.66)2.87 (1.40–5.89)2.66 (1.25–5.68)2.28 (1.06–4.93)2.26 (1.04–4.91)p = 0.0003p = 0.004p = 0.01p = 0.04p = 0.04Data are expressed as hazard ratio (95% confidence interval). Adjusted for age, gender, β blockers, and dihydropyridines.† Model 1 plus smoking, hypertension, hypercholesterolemia, diabetes mellitus, and body mass index.‡ Model 2 plus triple-vessel disease, New York Heart Association class III or IV, left ventricular ejection fraction <0.40, redo surgery, supraventricular arrhythmia, pulmonary disease, peripheral artery disease, cerebrovascular disease, and unstable cardiac status.§ Model 3 plus off-pump surgery, complete revascularization, statins, and angiotensin-converting enzyme inhibitors or angiotensin antagonists. Open table in a new tab DiscussionIn this study, we found that postoperative HR at rest measured 2 months after CABG was associated with long-term cardiovascular events. Higher HR was also associated with mortality, but this association was not found independent from other covariates. The strongest independent association between cardiovascular events and HR was demonstrated for values >90 beats/min. To our knowledge, this is the first specific study addressing the predictive value of HR in the setting of patients with coronary artery disease after CABG.In patients with stable coronary heart disease, Jeger et al12Jeger R.V. Probst C. Arsenic R. Lippuner T. Pfisterer M.E. Seeberger M.D. Filipovic M. Long-term prognostic value of the preoperative 12-lead electrocardiogram before major noncardiac surgery in coronary artery disease.Am Heart J. 2006; 151: 508-513Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar showed that preoperative HR is an independent long-term predictor of all-cause mortality after major noncardiac surgery, with an odds ratio of 1.6 (95% confidence interval 1.1 to 2.4) per 10 beats/min. Perioperative hemodynamic studies of patients who undergo CABG surgery have shown that intraoperative HR is also predictive of perioperative myocardial infarction and mortality,13Reich D.L. Bodian C.A. Krol M. Kuroda M. Osinski T. Thys D.M. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery.Anesth Analg. 1999; 89: 814-822PubMed Google Scholar with a cut-off value of 80 beats/min for an independent association with in-hospital mortality.14Fillinger M.P. Surgenor S.D. Hartman G.S. Clark C. Dodds T.M. Rassias A.J. Paganelli W.C. Marshall P. Johnson D. Kelly D. Galatis D. Olmstead E.M. Ross C.S. O'Connor G.T. The association between heart rate and in-hospital mortality after coronary artery bypass graft surgery.Anesth Analg. 2002; 95: 1483-1488Crossref PubMed Scopus (25) Google Scholar Previously, we showed that preoperative HR at rest was an independent predictor of perioperative cardiovascular events, including death, stroke, and perioperative myocardial infarction.4Aboyans V. Frank M. Nubret K. Lacroix P. Laskar M. Heart rate and pulse pressure at rest are major prognostic markers of early postoperative complications after coronary bypass surgery.Eur J Cardiothorac Surg. 2008; 33: 971-976Crossref PubMed Scopus (24) Google Scholar In this study, preoperative and postoperative HR showed a good correlation, but preoperative HR was not predictive of cardiovascular outcomes during this long-term follow-up. These results may be explained by a higher risk for the short-term postoperative morbidity and mortality in those with elevated preoperative HR and eventually by the limited size of our cohort. One could hypothesize that after coronary revascularization, patients shifted to a different hemodynamic state with a new risk level. Therefore, the HRs of survivors need to be reassessed postoperatively for a new long-term risk stratification.The positive correlation between rest HR and cardiovascular morbidity can be partly explained by sympathetic overactivity, causing hemodynamic and metabolic changes, which in turn are known to favor atherosclerosis.15Palatini P. Julius S. Heart rate and the cardiovascular risk.J Hypertens. 1997; 15: 3-17Crossref PubMed Scopus (417) Google Scholar This autonomic imbalance might be aggravated in the specific population of CABG surgery patients by a decreased vagal tone, because of perioperative autonomic nerve system damage.16Niemela M.J. Airaksinen K.E. Tahvanainen K.U. Linnaluoto M.K. Takkunen J.T. Effect of coronary artery bypass grafting on cardiac parasympathetic nervous function.Eur Heart J. 1992; 13: 932-935PubMed Google Scholar, 17Piha S.J. Hamalainen H. Effect of coronary bypass grafting on autonomic cardiovascular reflexes.Ann Med. 1994; 26: 53-56Crossref PubMed Scopus (10) Google ScholarThis study had several limitations. First, our study was an observational cohort study with a limited population sample size, which might induce lack of power in our statistical analyses. Second, our study considered major adverse prognostic factors for long-term outcomes after CABG, but we are unable to provide any further information regarding the patency of bypass grafts. Yet despite substantial evidence for higher long-term patency of arterial grafts, with proof of improved long-term survival,18Loop F.D. Lytle B.W. Cosgrove D.M. Stewart R.W. Goormastic M. Williams G.W. Golding L.A. Gill C.C. Taylor P.C. Sheldon W.C. Proudfit W. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events.N Engl J Med. 1986; 314: 1-6Crossref PubMed Scopus (2262) Google Scholar, 19Cameron A. Davis K.B. Green G. Schaff H.V. Coronary bypass surgery with internal-thoracic-artery grafts—effects on survival over a 15-year period.N Engl J Med. 1996; 334: 216-219Crossref PubMed Scopus (739) Google Scholar there is no evidence that graft patency could be related to postoperative rest HR. Also, we were unable to adjust for eventually persistent anemia. As postoperative HR measurement was performed on an outpatient basis inconsistent with severe anemia, substantial confounding bias should be limited. Finally, because of the enrollment period, the prescription of statins in our sample population was suboptimal, but despite their underuse, a correlation between HR and statins also seems unlikely.In our study, all-cause and cardiovascular mortality were consistent with recent observational studies of larger equivalent population samples.20Kimura T. Morimoto T. Furukawa Y. Nakagawa Y. Shizuta S. Ehara N. Taniguchi R. Doi T. Nishiyama K. Ozasa N. Saito N. Hoshino K. Mitsuoka H. Abe M. Toma M. Tamura T. Haruna Y. Imai Y. Teramukai S. Fukushima M. Kita T. Long-term outcomes of coronary-artery bypass graft surgery versus percutaneous coronary intervention for multivessel coronary artery disease in the bare-metal stent era.Circulation. 2008; 118: S199-S209Crossref PubMed Scopus (91) Google Scholar, 21Ketonen M. Pajunen P. Koukkunen H. Immonen-Raiha P. Mustonen J. Mahonen M. Niemela M. Kuulasmaa K. Palomaki P. Arstila M. Vuorenmaa T. Lehtonen A. Lehto S. Miettinen H. Torppa J. Tuomilehto J. Airaksinen J. Pyorala K. Salomaa V. Long-term prognosis after coronary artery bypass surgery.Int J Cardiol. 2008; 124: 72-79Abstract Full Text Full Text PDF PubMed Scopus (17) Google ScholarThe use of β blockers in stable and unstable coronary artery disease has been well established. Their prescription after CABG remains controversial because of limited proof of efficacy. Sjoland et al22Sjoland H. Caidahl K. Lurje L. Hjalmarson A. Herlitz J. Metoprolol treatment for two years after coronary bypass grafting: effects on exercise capacity and signs of myocardial ischaemia.Br Heart J. 1995; 74: 235-241Crossref PubMed Scopus (22) Google Scholar, 23The MACB Study GroupEffect of metoprolol on death and cardiac events during a 2-year period after coronary artery bypass grafting.Eur Heart J. 1995; 16: 1825-1832PubMed Google Scholar addressed this issue in a randomized, double-blinded, placebo-controlled clinical trial, using 100 mg of metoprolol during 2-year follow-up, demonstrating a lack of benefit in terms of mortality and protection against cardiovascular events in the metoprolol group. Even in coronary artery disease, despite strong evidence for deleterious effects of tachycardia, tight control of HR at rest has no proved clinical benefit.24Fox K. Ford I. Steg P.G. Tendera M. Ferrari R. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial.Lancet. 2008; 372: 807-816Abstract Full Text Full Text PDF PubMed Scopus (908) Google Scholar Our findings merely suggest a prognostic importance of postoperative HR, because this study was not designed to demonstrate deleterious effect of insufficient HR control due to the underdose of HR-lowering medications, or whether or not a tighter HR control could be of prognostic interest. Further large trials are still warranted to address this issue.In conclusion, in this study, we show that an increased ambulatory HR at rest measured during the first postoperative outpatient visit is predictive of cardiovascular events after CABG. The association between elevated HR and fatal and nonfatal events is robust to further adjustments to confounding factors, while our study failed to demonstrate an independent prognostic value of high HR when we limited our analysis to fatal events only. Further studies with optimal population sample sizes are necessary to implement these findings and to eventually confirm postoperative HR rest as a prognostic marker after CABG. Heart rate (HR) is a prognostic marker in patients with coronary artery disease.1Diaz A. Bourassa M.G. Guertin M.C. Tardif J.C. Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease.Eur Heart J. 2005; 26: 967-974Crossref PubMed Scopus (692) Google Scholar, 2Mauss O. Klingenheben T. Ptaszynski P. Hohnloser S.H. Bedside risk stratification after acute myocardial infarction: prospective evaluation of the use of heart rate and left ventricular function.J Electrocardiol. 2005; 38: 106-112Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 3Eagle K.A. Lim M.J. D" @default.
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• W2009394597 title "Usefulness of Postoperative Heart Rate as an Independent Predictor of Mortality After Coronary Bypass Grafting" @default.
• W2009394597 cites W177631884 @default.
• W2009394597 cites W1843397488 @default.
• W2009394597 cites W1964862831 @default.
• W2009394597 cites W1970118064 @default.
• W2009394597 cites W1973329445 @default.
• W2009394597 cites W1986117181 @default.
• W2009394597 cites W2022867885 @default.
• W2009394597 cites W2025308381 @default.
• W2009394597 cites W2039152447 @default.
• W2009394597 cites W2041598947 @default.
• W2009394597 cites W2072561339 @default.
• W2009394597 cites W2072602599 @default.
• W2009394597 cites W2072842765 @default.
• W2009394597 cites W2102948895 @default.
• W2009394597 cites W2130779254 @default.
• W2009394597 cites W2135292306 @default.
• W2009394597 cites W2157184686 @default.
• W2009394597 cites W2164145340 @default.
• W2009394597 cites W2321658691 @default.
• W2009394597 cites W2331162989 @default.
• W2009394597 cites W4214661190 @default.
• W2009394597 cites W4232711696 @default.
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