Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study

Abstract

Background: Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality.

Objective: To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI).

Methods: Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model.

Results: At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs.≥60years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40).

Conclusion: After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.

Trial registration: ClinicalTrials.gov NCT00673036.

Keywords: Acute myocardial infarction; Cardiac rehabilitation; Infarctus du myocarde aigu; Infarctus du myocarde avec sus-décalage du segment ST; Infarctus du myocarde sans sus-décalage du segment ST; Mortality; Mortalité; Non–ST-segment elevation myocardial infarction; Réadaptation cardiaque; ST-segment elevation myocardial infarction.