Published Online
on October 25, 2004

A more recent version of this article appeared on November 2, 2004

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Submitted on April 28, 2004
Revised on August 27, 2004
Accepted on September 8, 2004

Heart Rate Recovery and Impact of Myocardial Revascularization on Long-Term Mortality

Michael S. Chen MD, Eugene H. Blackstone MD, Claire E. Pothier MS, and Michael S. Lauer MD^*

From the Department of Cardiovascular Medicine (M.S.C., C.E.P., M.S.L.) and Departments of Cardiothoracic Surgery (E.H.B.) and Epidemiology and Biostatistics (E.H.B.), Cleveland Clinic Foundation, Cleveland, Ohio.

^* To whom correspondence should be addressed. E-mail: lauerm{at}ccf.org.

Background--Although heart rate recovery (HRR) predicts mortality after exercise testing, its ability to identify patients likely to benefit after revascularization is unknown. We sought to determine whether HRR can identify patients likely to have improved survival after revascularization.

Methods and Results--A total of 8861 patients undergoing treadmill nuclear or echocardiographic testing were divided into early revascularization (percutaneous coronary intervention or bypass surgery within 3 months) and non-early revascularization groups. Prespecified subgroup analysis was performed based on the presence or absence of ischemia, normal or impaired functional capacity, and normal or abnormal HRR. The primary end point was all-cause mortality. Early revascularization occurred in 552 patients. We propensity-matched 508 early revascularization patients to 508 non-early revascularization patients on the basis of 48 possible confounders. This constituted the present study cohort. During 8-year follow-up, 232 patients died. Overall, revascularization was associated with a slight but not significant decrease in mortality (hazard ratio [HR] 0.80, 95% CI 0.62 to 1.03). A significant decrease in mortality after revascularization was present in patients with imaging evidence of stress-induced ischemia (HR 0.62, 95% CI 0.44 to 0.87). Ischemic patients with normal HRR had significantly lower mortality with revascularization (HR 0.55, 95% CI 0.34 to 0.90), whereas ischemic patients with abnormal HRR did not (HR 0.78, 95% CI 0.47 to 1.29); however, the test for interaction between these 2 groups was not significant (P=0.34).

Conclusions--In patients with imaging evidence of myocardial ischemia, an abnormal HRR is associated with a nonsignificant trend toward blunting the survival improvement associated with early revascularization. HRR does not appear to identify patients likely to have a survival benefit.

Key words: heart rate • ischemia • revascularization • exercise • mortality

Related Article:

Heart Rate Recovery: Predictor of Risk Today and Target of Therapy Tomorrow?

Anthony P. Morise
Circulation 2004 110: 2778-2780. [Extract] [Full Text]

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