Patients with large myocardial infarction achieved significantly greater improvements in peak work rate and peak VO2 after a 3-month exercise training program than those with smaller MIs (p < 0.01).
Cohort (n=296)
Does a 3-month cardiac rehabilitation program improve exercise capacity more in patients with large myocardial infarction compared to those with small- to medium-size myocardial infarction?
Patients with large myocardial infarctions derive greater improvements in exercise capacity from cardiac rehabilitation than those with smaller infarctions, largely due to reversal of physical deconditioning and improvement in congestive heart failure.
p-value: p=< 0.01
BACKGROUND: It remains unclear whether patients with large-size myocardial infarction (MI) achieve the same benefit from exercise training as do those with small- to medium-size MI. HYPOTHESIS: This study was designed to determine the magnitude and mechanisms underlying improvement in exercise capacity in patients with large-size MI after cardiac rehabilitation. METHODS: In all, 296 patients who participated in a cardiac rehabilitation program after acute MI were divided into two groups according to the peak serum creatine phosphokinase (CPK) level: the group with large infarction (Group 1) (> or = 5000 U/l peak CPK, 64 patients) and the group with less extensive infarction (Group 2) (< 5000 U/I, 232 patients). Exercise capacity was assessed before and after a 3-month cardiac rehabilitation program that included exercise training. RESULTS: Before exercise training, both the peak work rate (p < 0.05) and peak oxygen uptake (VO2) (p < 0.01) were significantly lower in Group 1 than in Group 2. After exercise training, the changes in peak work rate and peak VO2 were significantly greater in Group 1 than in Group 2 (both p < 0.01). The infarction size measured by the peak CPK level correlated significantly with both the baseline exercise capacity and its improvement after exercise training, although these correlations were insignificant in a multivariate analysis. In the multivariate analysis, the improvement in exercise capacity is determined by age and baseline exercise capacity, which is determined by the duration of inactivity, minute ventilation (VE)/VCO2 slope and left ventricular end-diastolic pressure. CONCLUSIONS: Compared with patients with small- to medium-size myocardial infarction, patients with large infarction gain a greater improvement in exercise capacity after exercise training due to reversal of physical deconditioning and improvement in congestive heart failure.
Sakuragi et al. (Sun,) conducted a cohort in Acute myocardial infarction (n=296). Large-size myocardial infarction (peak CPK ≥ 5000 U/l) vs. Small- to medium-size myocardial infarction (peak CPK < 5000 U/l) was evaluated on Change in peak work rate and peak oxygen uptake (VO2) (p=< 0.01). Patients with large myocardial infarction achieved significantly greater improvements in peak work rate and peak VO2 after a 3-month exercise training program than those with smaller MIs (p < 0.01).
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