Yonsei Med J.  2019 Jun;60(6):535-541. 10.3349/ymj.2019.60.6.535.

Effect of Cardiac Rehabilitation on Outcomes in Patients with ST-Elevation Myocardial Infarction

• Lee HY
• Hong SJ
• Jung IH
• Kim GS
• Byun YS
• Kim BO

• KMID: 2446958
• DOI: http://doi.org/10.3349/ymj.2019.60.6.535

Abstract

PURPOSE
Whether cardiac rehabilitation (CR) improves clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) has not been thoroughly evaluated. Moreover, few studies have sought to identify patients who would benefit most from CR among STEMI patients.
MATERIALS AND METHODS
Consecutively, 265 STEMI patients who underwent primary PCI with implantation of DESs and follow-up angiography were examined. Seventy-six patients (30%) who received CR were assigned to the CR+ group. Another 178 patients (70%) who did not participate in CR were assigned to the CR− group. Second generation DESs were implanted in 238 (94%) patients.
RESULTS
Major adverse cardiovascular events (MACEs), including death, myocardial infarction, and revascularization, were compared. The CR+ group tended to have lower MACE than the CR− group at 3 years, although the difference was not statistically significant (9.9% vs. 18.3%, hazard ratio=0.54, p=0.138). Subgroup analysis revealed a significant interaction according to CR and preprocedural thrombolysis in myocardial infarction (TIMI) flow (p value for interaction=0.011). In patients with low preprocedural TIMI flow (TIMI flow ≤1, n=161), those in the CR+ group had significantly lower MACE than those in the CR− group (p=0.005), whereas MACE was not different among patients with higher TIMI flow (TIMI flow ≥2, n=93).
CONCLUSION
CR including exercise training was associated with lower MACE, particularly in patients with lower preprocedural TIMI flow during primary PCI for STEMI in the current DES era.

Keyword

Cardiac rehabilitation; myocardial infarction; drug eluting stent

MeSH Terms

Angiography
Drug-Eluting Stents
Follow-Up Studies
Humans
Myocardial Infarction*
Percutaneous Coronary Intervention
Rehabilitation*

Figure

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  Fig. 1 Kaplan-Meier survival curves of MACEs according to CR. CI, confidence interval; CR, cardiac rehabilitation; HR, hazard ratio; MACE, major adverse cardiovascular event; PCI, percutaneous coronary intervention.

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  Fig. 2 Subgroup analysis of major adverse cardiovascular events. CI, confidence interval; CR, cardiac rehabilitation; HR, hazard ratio; LAD, left anterior descending; LCx, left circumflex; RCA, right coronary artery; TIMI, thrombolysis in myocardial infarction.

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  Fig. 3 Kaplan-Meier survival curves of MACEs according to preprocedural TIMI flow. CR, cardiac rehabilitation; PCI, percutaneous coronary intervention; TIMI, thrombolysis in myocardial infarction; MACE, major adverse cardiovascular event.

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