Abstract:

Objective To observe the major adverse cardiac events (MACE) and to explore the predictive effects of sinus heart rate turbulence (HRT) and heart rate variability (HRV) on the prognosis of patients with acute coronary syndrome (ACS) through the perioperative detection and follow-up. Methods The prospective method was used for 167 patients who were diagnosed with ACS and underwent coronary angiography (CAG) and percutaneous coronary intervention (PCI) treatment. Delmar dynamic ECG detection system (USA) was used to give 24 h dynamic electrocardiogram examination for each patient within 2-4 weeks of onset. The HRT was evaluated by the turbulence onset (TO) and turbulence slope (TS) and the HRV was evaluated by the standard deviation of consecutive 24 h normal RR interval (SDNN). The followup was continued for at least 5 months and the occurrence of MACE was observed. Results There were 51 cases of abnormal HRT, among which 7 were with MACE (13.73%). Among 59 cases of normal HRT, 7 cases were with MACE (11.85%). The differences of the occurrence rate of MACE between patients with abnormal HRT and normal HRT were not statistically significant (P>0.05). The sensitivity, specificity, and accuracy of prediction of MACE for patients with ACS by the HRT were 50.0%, 54.2%, and 53.6%, respectively. The positive value and negative value of prediction of MACE for patients with ACS by the HRV were 9.1% and 92.4%, respectively. Decreased SDNN was relevant to the occurrence of MACE (P<0.05). Conclusion The perioperative 24-hour dynamic electrocardiogram examination is critical. Reduced HRV is important for predicting the prognosis of patients with ACS, while the predictive value of HRT is limited.

Key words: acute coronary syndrome, sinus heart rate turbulence, turbulence onset, turbulence slope, heart rate variability, standard deviation of consecutive 24 h normal RR interval