Key result
No-low risk stratification after acute coronary syndrome was independently associated with a higher rate of cardiac rehospitalization compared to low risk (18.4% vs 4.4%; adjusted HR 3.83, 95% CI 1.51-9.68).
Why the study?
Several risk scores predict risk after ACS, but none include functional class.
Does a risk stratification protocol incorporating functional capacity and LVEF predict cardiac rehospitalization and respond to exercise-based cardiac rehabilitation in patients after an acute coronary syndrome?
Cohort (n=238)
No
Does a risk stratification protocol incorporating functional capacity and LVEF predict cardiac rehospitalization and respond to exercise-based cardiac rehabilitation in patients after an acute coronary syndrome?
A simple post-ACS risk stratification score incorporating exercise capacity (METs) and LVEF strongly predicts cardiac rehospitalization, and completing exercise-based cardiac rehabilitation reclassifies half of high-risk patients to low risk with correspondingly improved prognosis.
Answers are grounded in this paper and cite their sources.
May support post-ACS stratification by exercise capacity and LVEF; leaves open prospective validation and rehabilitation effects.
Several risk scores have been used to predict risk after an acute coronary syndrome (ACS), but none of these risk scores include functional class. The aim was to assess the predictive value of risk stratification (RS), including functional class, and how cardiac rehabilitation (CR) changed RS. Two hundred and thirty-eight patients with ACS from an ambispective observational registry were stratified as low (L) and no-low (NL) risk and classified according to exercise compliance; low risk and exercise (L-E), low risk and control (no exercise) (L-C), no-low risk and exercise (NL-E), and no-low risk and control (NL-C). The primary endpoint was cardiac rehospitalization. Multivariable analysis was performed to identify variables independently associated with the primary endpoint. The L group included 56.7% of patients. The primary endpoint was higher in the NL group (18.4% vs. 4.4%, p < 0.001). After adjustment for age, sex, diabetes, and exercise in multivariable analysis, HR (95% CI) was 3.83 (1.51−9.68) for cardiac rehospitalization. For RS and exercise, the prognosis varied: the L-E group had a cardiac rehospitalization rate of 2.5% compared to 26.1% in the NL-C group (p < 0.001). Completing exercise training was associated with reclassification to low-risk, associated with a better outcome. This easy-to-calculate risk score offers robust prognostic information. No-exercise groups were independently associated with the worst outcomes. Exercise-based CR program changed RS, improving classification and prognosis.
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Cabrera-Aguilera et al. (2022) conducted a cohort in Acute coronary syndrome (ACS) attending cardiac rehabilitation (n=238). No-low risk stratification (SSC-EXCELENTE cardiac rehabilitation protocol including functional capacity <7 METs and LVEF <49%) vs. Low risk stratification was evaluated on Cardiac rehospitalization (hospital admission >24 h for arrhythmias, heart failure, ACS, or unplanned coronary revascularization) (HR 3.83, 95% CI 1.51-9.68, p=<0.001). No-low risk stratification after acute coronary syndrome was independently associated with a higher rate of cardiac rehospitalization compared to low risk (18.4% vs 4.4%; adjusted HR 3.83, 95% CI 1.51-9.68).
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