Key result
Early cardiac rehabilitation linked to ~70% lower MACE risk vs no rehabilitation in post-AMI HFrEF.
Why the study?
Studies on early cardiac rehabilitation in patients with acute myocardial infarction who developed congestive heart failure following PCI are rare.
Does early cardiac rehabilitation reduce MACE in patients with heart failure following acute myocardial infarction and PCI?
Cohort (n=237)
No
Does early cardiac rehabilitation reduce MACE in patients with heart failure following acute myocardial infarction and PCI?
Absolute Event Rate: 18.2% vs 60.6%
p-value: p=0.002
Early cardiac rehabilitation improves clinical outcomes by reducing cardiac death in HFrEF and re-hospitalization in HFmrEF patients following AMI and PCI.
May support early CR in post-AMI HF; hypothesis-generating and should not yet change practice.
Background: Cardiac rehabilitation (CR) has been shown to improve exercise intolerance and QoL, and minimize re-hospitalizations in patients with congestive heart failure (CHF). However, studies on early CR in patients with acute myocardial infarction (AMI) who developed CHF following percutaneous coronary intervention (PCI) are rare. The purpose of this study is to evaluate the effectiveness of early CR on patients with CHF after AMI following PCI.Methods: Two hundred thirty-seven patients who developed heart failure after AMI following PCI were enrolled. Patients were divided into heart failure with reduced ejection fraction (HFrEF) group (n=55) and heart failure with mid-range ejection fraction (HFmrEF) group (n=182). Of the 237 patients, 78 (22 in HFrEF group and 56 in HFmrEF group) who accepted a two-week CR were further divided into two subgroups based on major adverse cardiovascular events (MACE). Key cardio-pulmonary exercise testing (CPX) variables that may affect the prognosis were identified among the CR patients.Results: Early CR significantly reduced cardiac death in patients with HFrEF (18.2% vs. 60.6%, P=0.02), and reduced re-hospitalization in patients with HFmrEF after AMI (3.6% vs. 21.4%, P=0.02). Serum potassium and CR ratio were independent risk factors for MACE in patients with both HFrEF and HFmrEF after AMI. In the CR group who developed MACE, there were more diabetics (22.2% vs. 66.7%, P=0.035), with higher serum potassium (3.96mmol/l vs. 4.31mmol/l, P=0.043), and lower PETCO2 at ventilatory threshold (VT) (P=0.016). PETCO2 at VT was an independent risk factor for re-hospitalization. The incidence of re-hospitalization was significantly lower when the PETCO2 at VT was greater than 33.5mmHg (0(0.00% vs. 6(13.64%), P=0.03).Conclusions: Early CR reduced the incidence of MACE in patients with heart failure after AMI following PCI. The PETCO2 at VT is an independent risk factor for re-hospitalization, and could be used as a key evaluating hallmark for early CR in patients who developed heart failure after AMI.
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Cai et al. (2020) conducted a cohort in Heart failure after acute myocardial infarction following percutaneous coronary intervention (n=237). Early cardiac rehabilitation vs. No early cardiac rehabilitation was evaluated on Major adverse cardiovascular events (MACE) in HFrEF patients (p=0.002). Early cardiac rehabilitation significantly reduced the incidence of major adverse cardiovascular events compared to no rehabilitation in patients with heart failure after acute myocardial infarction.
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