Why the study?
Heart rate recovery is a strong mortality predictor post-myocardial infarction, but the effect of cardiac rehabilitation on it in diabetic STEMI patients treated with primary PCI needed evaluation.
Does an exercise-based cardiac rehabilitation program improve heart rate recovery in diabetic patients post-STEMI treated by primary PCI?
Does an exercise-based cardiac rehabilitation program improve heart rate recovery in diabetic patients post-STEMI treated by primary PCI?
An exercise-based cardiac rehabilitation program significantly improves heart rate recovery, a known prognostic marker, in diabetic patients following STEMI and primary PCI.
May support CR to improve HRR in diabetic post-STEMI patients; hypothesis-generating for outcome benefits.
Introduction: Diabetes Mellitus is associated with increased mortality from coronary artery disease. Cardiac rehabilitation (CR) is an evidence-based form of secondary prevention and is well-established in the effective management of patients with acute coronary syndrome (ACS). The heart rate is animportant prognostic factor of cardiovascular diseases. Heart rate recovery (HRR) is a strong independent mortality predictor in patients with previous myocardial infarction (MI). Aim: To study the effect of exercise based cardiac rehabilitation program on HRR in diabetic patients with ST segment elevation myocardial infarction (STEMI) post successful primary percutaneous coronary intervention (1ry PCI). Methods: Fifty diabetic patients, who presented with STEMI started CR program at Ain Shams cardiac rehabilitation unit 30 days post successful primary PCI after myocardial infarction. Before CR program they were subjected to a symptom limited exercise test (modified Bruce protocol) to exclude any remaining ischemia and calculate enrollment resting heart rate (HR), maximum HR, HR reserve, baseline HR recovery in 1st minute (HRR1) and 2nd minute (HRR2) into recovery. Another symptom limited exercise test was done after completion of the CR program. In order not to affect the results of the study, patients on beta blockers or other rate-reducing drugs, anti-hypertensive drugs, lipid lowering drugs and anti-diabetic drugs continued using the same doses during the study period. Results: There was statistically significant increase in HR reserve from 53.7±10.5 bpm to 64.1 ±11.8 bpm as well as significant increase in HRR1 and HRR2 from 12.3 ±2.8 bpm & 23.1± 6.45 bpm to 24.4 ±4.3 bpm & 39.1±4.7 bpm respectively after completion of the CR program (P-value<0.01). Conclusions: We conclude that in post MI diabetic patients treated by 1ry PCI, exercise based CR program improves the HR recovery which may have a positive prognostic effect on morbidity and mortality
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Khorshid et al. (2020) studied this question.
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