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

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.

Keywords: Cardiac rehabilitation; drug eluting stent; myocardial infarction.

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.

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.

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.