A NEW clinical study shows that impaired heart rate recovery can reliably predict periprocedural myocardial infarction, offering clinicians a simple, noninvasive tool to identify patients at increased risk before elective coronary interventions.
Understanding Periprocedural Myocardial Infarction
Periprocedural myocardial infarction remains one of the most common and clinically significant complications following elective percutaneous coronary intervention. Even small myocardial injuries occurring during PCI are associated with higher long-term mortality, recurrent cardiac events, and impaired functional recovery. Despite advances in interventional techniques, accurately identifying high-risk patients before the procedure has remained challenging. Heart rate recovery, which measures how quickly the heart rate declines after peak exercise, reflects autonomic nervous system balance. Slower recovery indicates impaired parasympathetic reactivation and heightened sympathetic activity, both of which increase susceptibility to ischemic injury.
Large-Scale Clinical Evidence
The study evaluated 401 patients who underwent elective PCI between 2022 and 2024. Heart rate recovery was assessed one and three minutes after cardiopulmonary exercise testing. Patients who developed periprocedural myocardial infarction showed significantly lower heart rate recovery at both time points. At one minute, recovery was 11.12 beats per minute compared with 14.21 beats per minute in patients without infarction. At three minutes, recovery was 42.99 beats per minute versus 48.36 beats per minute. Statistical modeling confirmed heart rate recovery as an independent predictor of periprocedural myocardial infarction. One-minute recovery demonstrated the strongest predictive power, with each incremental improvement associated with a meaningful reduction in infarction risk.
Clinical Implications
These findings highlight heart rate recovery as a valuable addition to preoperative risk assessment for PCI. Unlike complex imaging or laboratory testing, heart rate recovery is noninvasive, cost-effective, and easily incorporated into routine cardiopulmonary exercise testing. Integrating heart rate recovery into procedural planning may allow clinicians to identify high-risk patients earlier, adjust procedural strategies, optimize peri-procedural monitoring, and potentially reduce adverse cardiac outcomes. Future research will determine whether heart rate recovery–guided clinical strategies can directly lower rates of periprocedural myocardial infarction and improve long-term survival.
Reference
Bekler O, Kurtul A. Association of heart rate recovery assessed by cardiopulmonary exercise testing with periprocedural myocardial infarction after an elective percutaneous coronary intervention. Journal of Interventional Cardiology. 2025;2025(1):5514452.
