The initiation time and duration of exercise-based cardiac rehabilitation had no significant impact on changes in left ventricular ejection fraction (starting time estimate 0.160, p=0.130) in patients with acute myocardial infarction after percutaneous coronary intervention.
Meta-Analysis (n=1,810)
Does the initiation time and duration of exercise-based cardiac rehabilitation impact outcomes in patients with acute myocardial infarction after percutaneous coronary intervention?
There is no significant difference in the improvement of outcomes based on different cardiac rehabilitation starting times within 1 month after PCI or different durations of the programs in AMI patients.
Effect estimate: Estimate 0.160
p-value: p=0.130
BACKGROUND AND OBJECTIVE: Cardiac rehabilitation (CR) has been demonstrated to improve outcomes in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). However, the optimal CR initiation time and duration remain to be determined. This study aimed to explore the impact of the time factors on the CR outcomes in AMI patients who received PCI by the method of meta-regression analysis. METHODS: We searched five databases (PubMed, Embase, Cochrane Library, Web of Science and Google scholar) up to October 31, 2023. Meta-regression analysis was utilized to explore the impact of the time factors on the effect sizes. Subgroups with more than 3 studies were used for meta-regression analysis. RESULTS: Our analysis included 16 studies and a total of 1810 patients. The meta-regression analysis revealed that the initiation time and duration of CR had no significant impact on the occurrence of arrhythmia, coronary artery restenosis and angina pectoris. The initiation time and duration of CR also had no significant impact on the changes in left ventricular ejection fraction (LVEF, starting time: estimate = 0.160, p = 0.130; intervention time: estimate = 0.017, p = 0.149), left ventricular end-diastolic volume (LVEDV, starting time: estimate = - 0.191, p = 0.732; intervention time: estimate = - 0.033, p = 0.160), left ventricular end-systolic volume (LVESV, starting time: estimate = - 0.301, p = 0.464; intervention time: estimate = 0.015, p = 0.368) and 6-minute walk test (6MWT, starting time: estimate = - 0.108, p = 0.467; intervention time: estimate = 0.019, p = 0.116). CONCLUSION: Implementation of CR following PCI in patients with AMI is beneficial. However, in AMI patients, there is no significant difference in the improvement of CR outcomes based on different CR starting times within 1 month after PCI or different durations of the CR programs. It indicates that it is feasible for patients with AMI to commence CR within 1 month after PCI and continue long-term CR, but the time factors which impact CR are intricate and further clinical research is still needed to determine the optimal initiation time and duration of CR.
Zhang et al. (Sat,) conducted a meta-analysis in Acute myocardial infarction after percutaneous coronary intervention (n=1,810). Exercise-based cardiac rehabilitation vs. No exercise (usual care) was evaluated on Impact of cardiac rehabilitation starting time on left ventricular ejection fraction (LVEF) in RCTs (Estimate 0.160, p=0.130). The initiation time and duration of exercise-based cardiac rehabilitation had no significant impact on changes in left ventricular ejection fraction (starting time estimate 0.160, p=0.130) in patients with acute myocardial infarction after percutaneous coronary intervention.