Impact of a Cardiac Rehabilitation Programme After a Myocardial Infarction in Individuals Not Undergoing Revascularisation: New Horizons for a Time-Tested Intervention - European Medical Journal

Impact of a Cardiac Rehabilitation Programme After a Myocardial Infarction in Individuals Not Undergoing Revascularisation: New Horizons for a Time-Tested Intervention

2 Mins
*Eduardo M. Vilela,1 Ricardo Ladeiras-Lopes,1 Marisa Silva,1 Catarina Ruivo,2 Fátima Miranda,3 Lilibeth Campos,3 Ana João,1 Susana Torres,1 Marlene Fonseca,1 José Ribeiro,1 Ricardo Fontes-Carvalho,1 João Primo,1 Madalena Teixeira,1 Vasco Gama,1 Pedro Braga1

The authors have declared no conflicts of interest.

EMJ Cardiol. ;6[1]:53-55. Abstract Review No. AR2. .
Acute coronary syndromes, cardiac rehabilitation (CR), myocardial infarction (MI), second-ary prevention

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

Cardiac rehabilitation (CR) plays a pivotal role in the contemporary management of myocardial infarction (MI) patients1 and several studies have documented the significant benefits on cardiovascular outcomes, both in terms of morbidity and mortality.2,3 CR has greatly evolved since its introduction and this has been reflected by the expanding indications for this holistic intervention.1,3 Exercise training exerts several physiological effects via both cardiac and extracardiac mechanisms,3,4 and has become one of the mainstays of CR programmes.3 Despite these positive data, certain patient subgroups tend to be referred to CR less often.3,5 Of these, patients not undergoing revascularisation present a particularly complex challenge given their suboptimal referral5 and higher risk status.6

A study by our group assessed the impact of a Phase II CR programme among MI survivors not undergoing revascularisation during hospitalisation, in terms of functional parameters assessed by cardiopulmonary exercise testing using a treadmill.7 A total of 349 patients from a single tertiary centre were included in this retrospective cohort study and the study population was mainly composed of male individuals (81.2%), with a mean age of 59.0±10.5 years. Of these, 12.6% had not been submitted to revascularisation during hospitalisation. Significant differences were present in terms of age, sex, history of coronary artery disease, prevalence of arterial hypertension, and smoking status. After the CR programme (mean number of sessions: 21.1±6.7), patients presented with significant improvements in cardiorespiratory fitness, as assessed by peak oxygen consumption (pVO2). Importantly, although patients not undergoing revascularisation during hospitalisation had a significantly lower pVO2 than the remaining patients (both at the beginning and at the end of the CR programme), there were no differences between these groups in terms of the benefit derived from the CR programme. This finding was maintained after adjusting for age and sex. Additionally, no differences were present between the groups in terms of the respiratory exchange ratio.

Previous data from patients with incomplete revascularisation have showed that a CR programme could be beneficial.8 In a study of 190 patients after an acute coronary syndrome (49 with incomplete revascularisation), a CR programme was well tolerated and presented significant increases in workload capacity, which did not differ between the study groups. Additionally, it should be noted that patients who did not undergo revascularisation tended to present with different risk profiles, namely in terms of a higher prevalence of comorbidities.6,9 As a result, the global scope of CR makes this intervention especially attractive for this subgroup of MI patients. The improvement in cardiorespiratory fitness (as assessed by pVO2) should also be highlighted since exercise capacity has been described as an important predictor of cardiovascular events in different groups of individuals.10

In conclusion, the results of the present study highlight the importance of CR programmes in MI survivors, namely in those who do not undergo revascularisation during hospitalisation. Future research should further explore this issue to fully ascertain the overall impact of CR on this higher-risk population, whose unmet needs in terms of secondary prevention still need to be improved.

Ibanez B et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. Rauch B et al. The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS). Eur J Prev Cardiol. 2016;23(18):1914-39. Fontes-Carvalho R et al., “The effect of exercise training in systolic and diastolic function,” Watson RR, Zibadi S (eds.), Lifestyle in Heart Health and Disease (2018), London: Academic Press, pp.153-62. Vilela EM et al. High-sensitivity troponin after running – A systematic review. Neth J Med. 2014;72(1):5-9. Dunlay SM et al. Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction. Am J Med. 2014;127(6):538-46. Jernberg T et al. Cardiovascular risk in post-myocardial infarction patients: Nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015;36(19):1163-70. Vilela EM et al. Impact of cardiac rehabilitation programs among myocardial infarction survivors not undergoing revascularization. Abstract 57. ESC Congress, 25-29 August, 2018. Rechciński T et al. Beneficial effects of cardiac rehabilitation in patients with incomplete revascularization  after primary coronary angioplasty. Eur J Phys Rehabil Med. 2013;49(6):785-91. Hanna EB et al. Characteristics and in-hospital outcomes of patients presenting with non-ST-segment elevation myocardial infarction found to have significant coronary artery disease on coronary angiography and managed medically: Stratification according to renal function. Am Heart J. 2012;164(1):52-7. Hung RK et al. Prognostic value of exercise capacity in patients with coronary artery disease: The FIT (Henry Ford ExercIse Testing) project. Mayo Clin Proc. 2014;89(12):1644-54.

Join our mailing list

To receive the EMJ updates straight to your inbox free of charge, please click the button below.
Join Now