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

Abstract

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.

Key words::

• ACOS registry
• Cardiac rehabilitation
• Myocardial infarction
• Non-ST elevation myocardial infarction
• Prognosis
• ST elevation myocardial infarction

Transparency

Declaration of funding

The ACOS registry was supported by a grant of MSD Sharp & Dohme, Haar, Germany. Retrospective data acquisition from relatives and physicians of the deceased patients and data analysis was performed under the responsibility and support of ‘Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany’.

Declaration of financial/other relationships

K.B. has disclosed that he is an employee of MSD Sharp & Dohme and that he has participated in the planning of the ACOS registry. B.R. and J.S. have disclosed that they have received lecture fees and compensation for travel expenses from MSD Sharp & Dohme. The other co-authors have nothing to disclose.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgement

The authors thank Elke Becker-Wördenweber for its assistance in performing this study. They also thank colleagues of the participating study centres for their fundamental work in creating the ACOS registry. The ACOS study centres have recently been published16.

Some of the data presented in this paper were presented during the 2005 Annual Meetings of the German Society of Cardiology in Mannheim, the German Society of Cardiovascular Prevention and Rehabilitation (DGPR) in Berlin and the European Society of Cardiology (ESC) in Stockholm.