Sex-related Differences in Exercise Capacity Trends and Determinants after Cardiac Rehabilitation in Patients with Acute Myocardial Infarction

Objective: This study aimed to investigate whether longitudinal changes in exercise capacity in patients with acute myocardial infarction (AMI) differ by sex and clarified what contributed to these differences. Methods: We retrospectively examined the differences in each variable between men and women in 156 patients with AMI (mean age: 65 ± 12 years; 82.0% male) who participated in a 3-month cardiac rehabilitation (CR) program and could be followed-up for exercise capacity 12-months after AMI onset. Sex-related differences in the change in peak oxygen uptake (peak VO2) at baseline, 3-months, and 12-months after AMI were analyzed. Results: Male patients with AMI were younger and had higher body mass index and employment rate than women. The attendance of the CR program was higher in women (men vs. women; 10 [3–15] vs. 14 [11–24] sessions, p = 0.0002). Women showed a significant lower %change in peak VO2 after 12 months (men vs. women; 7.8% [–0.49% to 14.6%] vs. 1.3% [–5.7% to 7.5%], p = 0.013). In multiple linear regression analysis, age (β = –0.76, 95% confidence interval [CI] = –1.0 to –0.50, p <0.0001) and female sex (β = –6.3, 95% CI = –9.1 to –3.5, p <0.0001) were negative independent predictors of change in peak VO2 over 12 months, while CR attendance (β = 0.21, 95% CI = 0.0032–0.42, p = 0.047) and recommended exercise habit after the CR program (β = 2.1, 95% CI = 0.095–4.1, p = 0.040) were positive independent predictors of change in peak VO2 over 12 months. Conclusion: In female patients, exercise capacity improved during the CR program but decreased to AMI onset levels after 12 months.