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

다국어 초록 (Multilingual 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 thoroughlyevaluated. 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 followupangiography 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 andpreprocedural thrombolysis in myocardial infarction (TIMI) flow (p value for interaction=0.011). In patients with low preproceduralTIMI 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 preproceduralTIMI flow during primary PCI for STEMI in the current DES era.

참고문헌 (Reference)

1 Suaya JA, "Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery" 116 : 1653-1662, 2007

2 Thygesen K, "Third universal definition of myocardial infarction" 126 : 2020-2035, 2012

3 Cottin Y, "Specific profile and referral bias of rehabilitated patients after an acute coronary syndrome" 24 : 38-44, 2004

4 Hammill BG, "Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries" 121 : 63-70, 2010

5 Lee HY, "Regular exercise training reduces coronary restenosis after percutaneous coronary intervention in patients with acute myocardial infarction" 167 : 2617-2622, 2013

6 Hambrecht R, "Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease : a randomized trial" 109 : 1371-1378, 2004

7 Stone GW, "Normal flow(TIMI-3)before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction : analysis from the primary angioplasty in myocardial infarction trials" 104 : 636-641, 2001

8 Clark AM, "Meta-analysis : secondary prevention programs for patients with coronary artery disease" 143 : 659-672, 2005

9 Joost A, "Impact of initial culprit vessel flow on infarct size, microvascular obstruction, and myocardial salvage in acute reperfused STelevation myocardial infarction" 118 : 1316-1322, 2016

10 Taylor RS, "Exercise-based rehabilitation for patients with coronary heart disease : systematic review and meta-analysis of randomized controlled trials" 116 : 682-692, 2004

11 Sabaté M, "Comparison of newer-generation drug-eluting with bare-metal stents in patients with acute ST-segment elevation myocardial infarction : a pooled analysis of the EXAMINATION(clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION)and COMFORTABLE-AMI(Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction)trials" 7 : 55-63, 2014

12 Palmerini T, "Clinical outcomes with drug-eluting and baremetal stents in patients with ST-segment elevation myocardial infarction : evidence from a comprehensive network meta-analysis" 62 : 496-504, 2013

13 Sabaté M, "Clinical outcomes in patients with ST-segment elevation myocardial infarction treated with everolimus-eluting stents versus bare-metal stents(EXAMINATION) : 5-year results of a randomised trial" 387 : 357-366, 2016

14 Pouche M, "Cardiac rehabilitation and 5-year mortality after acute coronary syndromes : The 2005 French FAST-MI study" 109 : 178-187, 2016

15 Cutlip DE, "Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions" 115 : 2344-2351, 2007

16 Smith SC Jr, "AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease : 2011 update : a guideline from the American Heart Association and American College of Cardiology Foundation" 124 : 2458-2473, 2011

17 Writing Committee Members, "AACVPR/ACCF/AHA 2010 update:performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: a report of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Clinical Performance Measures for Cardiac Rehabilitation)" 122 : 1342-1350, 2010