What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (n=2318). Intervention: Multidisciplinary cardiac rehabilitation program vs. No cardiac rehabilitation. Primary outcome: 10-year mortality (HR 0.61, 95% CI 0.46-0.81, p=<0.001).

January 2, 2018Open Access

Cardiac rehabilitation in patients with acute coronary syndrome with primary percutaneous coronary intervention is associated with improved 10-year survival

Q: What are the key findings of this study?

Cardiac rehabilitation after primary PCI for acute coronary syndrome was associated with lower 10-year mortality compared to no rehabilitation (14.7% vs. 23.5%; HR 0.61; 95% CI 0.46-0.81).

Key Result

Cardiac rehabilitation after primary PCI for acute coronary syndrome was associated with lower 10-year mortality compared to no rehabilitation (14.7% vs. 23.5%; HR 0.61; 95% CI 0.46-0.81).

Study Design

Type

Cohort (n=2,318)

Structured PICO

Does a multidisciplinary cardiac rehabilitation program improve survival in patients with acute coronary syndrome treated with primary percutaneous coronary intervention?

Population

2,318 propensity-matched patients who survived at least 60 days after primary PCI for acute coronary syndrome, followed for up to 10 years.

Exposure

Multidisciplinary cardiac rehabilitation (CR) program

Comparator

No cardiac rehabilitation (1:1 propensity matched)

Outcome

Survival/mortality at 5 and 10 yearshard clinical

Participation in a multidisciplinary cardiac rehabilitation program after pPCI for ACS is associated with significantly improved 10-year survival.

Main Result

Hazard Ratio: 0.61 (95% CI 0.46–0.81)

Absolute Event Rate: 14.7% vs 23.5%

p-value: p=<0.001

Abstract

Aims: We aimed to assess the effects of a multidisciplinary cardiac rehabilitation (CR) program on survival after treatment with primary percutaneous coronary intervention (pPCI) for acute coronary syndrome (ACS). Methods and results: Using propensity matching analysis, a total of 1159 patients undergoing CR were 1:1 matched with ACS patients who did not undergo CR and survived at least 60 days. The Kaplan-Meier analyses and multivariate Cox regression analysis were applied to study differences in survival. During follow-up, a total of 335 (14.5%) patients had died. Cumulative mortality rates at 5 and 10 years were 6.4% and 14.7% after CR and 10.4% and 23.5% in the no CR group (P < 0.001). Cardiac rehabilitation patients had 39% lower mortality than non-CR controls 10-year mortality 14.7% vs. 23.5%; adjusted hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.46-0.81. A total of 915 (78.9%) patients completed CR and had 46% lower mortality than those who did not complete CR (10-year mortality 13.6% vs. 18.9%; adjusted HR 0.54; 95% CI 0.42-0.70). Conclusion: Patients who underwent pPCI for ACS, with a CR program had lower mortality than their non-CR counterparts. Mortality was particularly low in patients who completed the program. In conclusion, CR is still beneficial in terms of survival.