Effect of early short-term cardiac rehabilitation after acute ST-elevation and non-ST-elevation myocardial infarction on 1-year mortality

TY - JOUR

T1 - Effect of early short-term cardiac rehabilitation after acute ST-elevation and non-ST-elevation myocardial infarction on 1-year mortality

AU - Jünger, Claus

AU - Rauch, Bernhard

AU - Schneider, Steffen

AU - Liebhart, Nadine

AU - Rauch, Geraldine

AU - Senges, Jochen

AU - Bestehorn, Kurt

PY - 2010/4

Y1 - 2010/4

N2 - OBJECTIVES: The aim was to evaluate the effect of short-term cardiac rehabilitation (CR) on clinical events during a 1-year follow-up after acute myocardial infarction.METHODS: From the observational, prospective Acute COronary Syndromes (ACOS) registry, 4547 consecutive patients after ST-elevation (STEMI: n = 2432) or non-ST-elevation myocardial infarction (NSTEMI: n = 2115), recruited between June 2000 and December 2002, were characterised and evaluated for clinical outcomes during a 1-year follow-up. From the STEMI group 67.8% and from the NSTEMI group 52.3% participated in cardiac rehabilitation (CR+).RESULTS: Age > 70 years and previous myocardial infarction were independent predictors not to attend CR in STEMI and NSTEMI patients, whereas early revascularisation (<48 hours after hospital admission) was associated with increased likelihood to undergo CR. Multivariable analysis adjusting for propensity score shows that CR+ was independently associated with a significant reduction of all-cause mortality (STEMI: OR 0.41, 95% CI 0.28-0.60; NSTEMI: OR 0.53, 95% CI 0.38-0.76) and major adverse cardiac and cerebrovascular events (MACCE; STEMI: OR 0.66, 95% CI 0.49-0.89; NSTEMI: OR 0.73, 95% CI 0.55-0.98) during a 1-year follow-up.CONCLUSION: The study shows an independent and strong association of CR+ with markedly reduced total mortality and MACCE during a 1-year follow-up after STEMI or NSTEMI. The limitation of the study is that it is not a prospective randomised trial. Furthermore, unequal distribution of risk factors relevant for long-term prognosis had to be corrected by multivariable analysis adjusting for propensity score.

AB - OBJECTIVES: The aim was to evaluate the effect of short-term cardiac rehabilitation (CR) on clinical events during a 1-year follow-up after acute myocardial infarction.METHODS: From the observational, prospective Acute COronary Syndromes (ACOS) registry, 4547 consecutive patients after ST-elevation (STEMI: n = 2432) or non-ST-elevation myocardial infarction (NSTEMI: n = 2115), recruited between June 2000 and December 2002, were characterised and evaluated for clinical outcomes during a 1-year follow-up. From the STEMI group 67.8% and from the NSTEMI group 52.3% participated in cardiac rehabilitation (CR+).RESULTS: Age > 70 years and previous myocardial infarction were independent predictors not to attend CR in STEMI and NSTEMI patients, whereas early revascularisation (<48 hours after hospital admission) was associated with increased likelihood to undergo CR. Multivariable analysis adjusting for propensity score shows that CR+ was independently associated with a significant reduction of all-cause mortality (STEMI: OR 0.41, 95% CI 0.28-0.60; NSTEMI: OR 0.53, 95% CI 0.38-0.76) and major adverse cardiac and cerebrovascular events (MACCE; STEMI: OR 0.66, 95% CI 0.49-0.89; NSTEMI: OR 0.73, 95% CI 0.55-0.98) during a 1-year follow-up.CONCLUSION: The study shows an independent and strong association of CR+ with markedly reduced total mortality and MACCE during a 1-year follow-up after STEMI or NSTEMI. The limitation of the study is that it is not a prospective randomised trial. Furthermore, unequal distribution of risk factors relevant for long-term prognosis had to be corrected by multivariable analysis adjusting for propensity score.

KW - Aged

KW - Female

KW - Germany

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Mortality

KW - Multivariate Analysis

KW - Myocardial Infarction

KW - Prognosis

KW - Prospective Studies

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1185/03007991003604216

DO - 10.1185/03007991003604216

M3 - SCORING: Journal article

C2 - 20121656

VL - 26

SP - 803

EP - 811

JO - CURR MED RES OPIN

JF - CURR MED RES OPIN

SN - 0300-7995

IS - 4

ER -