Impact of heart rate in atrial fibrillation versus sinus rhythm on mortality in octogenarian patients with acute coronary syndrome

INTRODUCTION: Association of heart rate (HR) with mortality in patients with acute coronary syndrome (ACS) and aged greater than 80 years are underrepresented in clinical trials. We therefore aimed to investigate the association of HR in atrial fibrillation (AF) versus sinus rhythm (SR) with all-cause mortality in octogenarian patients with ACS. METHODS: a total of 336 patients with ACS patients and aged 80 years were enrolled into the current study. The end point of interest was death from any cause. Association of HR in AF versus SR with mortality was analyzed by Kaplan-Meier curve following log-rank test and multivariable Cox regression analysis. RESULTS: in total, 63 (87.5%) of patients with AF were dead and 147 (59.8%) of patients with SR were dead during the follow-up period. The best cut-off was 80 bpm, with a sensitivity of 62% and specificity of 66%. HR 80 bpm in SR but not in AF was associated with better outcome as compared with HR = 80 bpm (Chi-Square = 26.55, Log rank P = 0.001). In SR subgroup, the hazard ratios of HR 80 bpm were 0.51(95% CI 0.37-0.70, P = 0.001) adjusted for age, 0.46 (95%CI 0.33-0.63, P = 0.001) adjusted for gender, 0.62 (95%CI 0.42- 0.93, P = 0.020) adjusted for multivariables respectively. In AF subgroup, the hazard ratios of HR = 80 bpm were 0.83(95% CI 0.49-1.38, P = 0.464) adjusted for age, 0.96 (95%CI 0.59-1.58, P = 0.882) adjusted for gender, 0.72(95% CI 0.41-1.26, P = 0.249) adjusted for multivariables respectively. CONCLUSION: the current study demonstrates that heart rate is an independent prognostic predictor for all-cause mortality, and HR 80 bpm is associated with improved outcome in SR but not in AF in octogenarian patients with ACS.