Key result
Cardiac rehabilitation was associated with a non-significant reduction in major adverse cardiovascular events at 3 years compared to no rehabilitation (9.9% vs. 18.3%, HR 0.54, p=0.138).
Why the study?
Whether cardiac rehabilitation improves clinical outcomes in STEMI patients undergoing primary PCI with drug-eluting stents has not been thoroughly evaluated, and few studies have identified which patients benefit most.
Does cardiac rehabilitation reduce major adverse cardiovascular events in STEMI patients undergoing primary PCI with DESs?
Cohort (n=254)
No
Does cardiac rehabilitation reduce major adverse cardiovascular events in STEMI patients undergoing primary PCI with DESs?
Answers are grounded in this paper and cite their sources.
Cardiac rehabilitation may reduce major adverse cardiovascular events in STEMI patients undergoing primary PCI, particularly those with low preprocedural TIMI flow.
Purpose: Whether cardiac rehabilitation (CR) improves clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) has not been thoroughly evaluated.Moreover, few studies have sought to identify patients who would benefit most from CR among STEMI patients.Materials and Methods: Consecutively, 265 STEMI patients who underwent primary PCI with implantation of DESs and followup angiography were examined.Seventy-six patients (30%) who received CR were assigned to the CR+ group.Another 178 patients (70%) who did not participate in CR were assigned to the CR-group.Second generation DESs were implanted in 238 (94%) patients.Results: Major adverse cardiovascular events (MACEs), including death, myocardial infarction, and revascularization, were compared.The CR+ group tended to have lower MACE than the CR-group at 3 years, although the difference was not statistically significant (9.9% vs. 18.3%, hazard ratio=0.54,p=0.138).Subgroup analysis revealed a significant interaction according to CR and preprocedural thrombolysis in myocardial infarction (TIMI) flow (p value for interaction=0.011).In patients with low preprocedural TIMI flow (TIMI flow ≤1, n=161), those in the CR+ group had significantly lower MACE than those in the CR-group (p=0.005),whereas MACE was not different among patients with higher TIMI flow (TIMI flow ≥2, n=93).Conclusion: CR including exercise training was associated with lower MACE, particularly in patients with lower preprocedural TIMI flow during primary PCI for STEMI in the current DES era.
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Lee et al. (2019) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=254). Cardiac rehabilitation vs. No cardiac rehabilitation was evaluated on Major adverse cardiovascular events (MACE) at 3 years (HR 0.54, 95% CI 0.23-1.24, p=0.138). Cardiac rehabilitation was associated with a non-significant reduction in major adverse cardiovascular events at 3 years compared to no rehabilitation (9.9% vs. 18.3%, HR 0.54, p=0.138).
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