Cardiac Rehabilitation of Patients with Acute ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in a Han Population in Northern China: A Prospective Cohort Study

Abstract

Background Cardiac rehabilitation (CR) has been associated with improved cardiac function in cardiovascular diseases. Our aim was to explore the factors associated with cardiac function and CR. Methods This prospective cohort study had 473 STEMI patients admitted for primary percutaneous coronary intervention (PCI) who were divided into a CR group (group A, n = 104) and a non-CR group (group B, n = 369) based on whether they could complete CR. Patients’ clinical features, such as age, hyperlipidemia, family history of premature coronary heart disease (FHPCHD), smoking history, body mass index (BMI, kg/m 2 ), number of diseased vessels, arrhythmia during PCI, N-terminal pro–B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF) and major adverse cardiac events (MACEs) at 6 months after PCI were compared. Then, the clinical characteristics of patients were further analyzed according to those with MACEs (n = 78) and those without MACEs (n = 395). Results After CR of 6 months, NT-proBNP levels (p = 0.027), 6-MWD (meter, P = 0.000), LVEF (P = 0.000) were significantly improved in group A compared to group B, but not for SMWA (P = 0.875). Multivariate analysis indicated that even though patients in group A (OR 3.06, 95% CI 1.132–8.274, p = 0.03) have a higher incidence of hyperlipidemia, their MACEs (OR 0.191, 95% CI 0.038–0.961, p = 0.05) at 6 months were significantly lower than in group B, mainly because the average patient low age (<65 years, OR 0.917, 95% CI 0.859–0.979, p = 0.01) and significant improvement of 6-MWD (OR 7.999, 95% CI 4.342–14.737, P = 0.00) and the LVEF at 6 months (OR 1.112, 95% CI 1.072–1.154, p = 0.00). Further analysis based on the MACES outcomes showed that there were 6 factors associated with the occurrence of MACEs, they were age >65 years (OR 1.032, 95% CI 1.009–1.009, p = 0.007), smoking history (OR 0.485, 95% CI 0.238–0.989, p = 0.046), education level (OR 2.646, 95% CI 1.370–5.108, p = 0.004), 6-MWD (OR 1.688, 95% CI 1.104–2.811, p = 0.044), LVEF (OR 0.958, 95% CI 0.926–0.991, p = 0.013) and CR (OR 6.271, 95% CI 2.236–17.590, p = 0.000). Conclusion CR, including exercise rehabilitation, is a beneficial option to reduce MACEs in STEMI patients treated with primary PCI.

The impact of the time factors on the exercise-based cardiac rehabilitation outcomes of the patients with acute myocardial infarction after percutaneous coronary intervention: a systematic review and meta-analysis

“…These studies were published in English between 2003 and 2023, with 11 studies conducted in China [ 12 – 15 , 24 – 30 ] and one study each conducted in Japan [ 31 ], Korea [ 32 ], Brazil [ 33 ], Iran [ 34 ], and Pakistan [ 35 ]. 10 studies were RCTs [ 12 – 15 , 24 , 25 , 29 , 31 , 33 , 34 ], 2 studies were retrospective cohort studies [ 26 , 28 ], and 4 study was a prospective cohort study [ 27 , 30 , 32 , 35 ]. The included studies involved a total of 1810 patients (774 patients in the rehabilitation group and1036 patients in the control group).…”

“…Among the observational studies, only one study used blind methods to measure the outcomes [ 32 ]. There was a significant difference in the number of participants between the experimental group and the control group in an observational study and we believed that comparability poses a high risk [ 27 ]. In short, most of the included studies’ quality were moderate (S_Fig.…”

“…Thirteen studies reported the mean and standard deviation (SD) of LVEF (9 RCTs [ 12 – 15 , 24 , 25 , 29 , 31 , 34 ] and 4 observational studies [ 26 , 27 , 30 , 35 ]), 4 studies (2RCTs [ 13 , 34 ] and 2 observational studies [ 26 , 30 ]) reported left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD), 4 RCTs [ 12 , 24 , 29 , 34 ] reported left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). The mean and SD of the changes in echocardiography parameters before and after intervention in both rehabilitation and control groups were calculated on an online platform [ 22 ].…”

“…Seven studies reported the mean and SD of 6MWT before and after intervention in both rehabilitation and control groups (4 RCTs [ 14 , 15 , 29 , 33 ] and 3 observational studies [ 26 , 27 , 30 ]). The results of the meta-regression analysis of RCTs did not reveal any significant association between changes in 6MWT and either initiation time or duration (starting time: estimate = − 0.108, p = 0.467; intervention time: estimate = 0.019, p = 0.116, S_Table 2 and Fig.…”

Application of early warning system (EWS) in patients with cardiovascular disorders : a descriptive study

“…Pasien yang menderita stemi inferior maka denyut nadinya akan selalu rendah, sehingga pada pasien pasca infark miokard akut inferior sangat baik bila dilakukan rehabilitasi jantung fase 1 yang akan dapat membantu meningkatkan denyut nadi. rehabilitasi jantung fase 1 pada pasien penyakit jantung koroner harus sesegera mungkin dilakukan bila sudah bebas nyeri dada, tidak sesak nafas, denyut nadi tidak melebihi batas 120x/menit [21].…”