Abstract 17716: Comprehensive Cardiac Rehabilitation Following Myocardial Infarction Improves Clinical Outcomes Regardless of Exercise Capacity in a Long-Term Follow-Up

Abstract

Background: Reduced exercise capacity is recognized as a prognostic indicator of adverse outcomes in patients with myocardial infarction (MI). However, there is limited research evaluating the effectiveness of comprehensive cardiac rehabilitation (CR) in this population. Here, we show for the first time that participation in CR can improve the prognosis of MI patients with reduced exercise capacity in a long-term study. Methods: This cohort study included 610 consecutive patients with MI who underwent percutaneous coronary intervention (PCI) between 2008 and 2015. Patients who received supervised CR were divided into two groups according to the duration of CR: the non-CR group (only hospitalization) and the CR group (continued to outpatient-CR). Within the CR group, patients were further divided into a reduced exercise capacity group (% predicted peak VO2 <80%) and a preserved exercise capacity group (≥80%). Comprehensive CR consisted of a 150-day supervised exercise program at the anaerobic threshold (AT) performed in the hospital under the supervision of a multidisciplinary team. Major adverse cardiovascular events (MACE) were compared among groups. Results: Mean follow-up was 6.1 ± 4.0 years. The MI patients were divided into three groups: the non-CR group (n = 180), the CR group with reduced exercise capacity (n = 241, peak VO2: 17.2 ± 3.9 ml/min/kg) and with preserved exercise capacity (n = 147, peak VO2: 23.1 ± 4.6 ml/min/kg). There was no significant difference in the improvement of the lower limb exercise capacity index, AT, peak VO2 and risk of MACE between the CR groups with reduced and preserved exercise capacity. However, the risk of MACE was lower in the CR groups compared with the non-CR group (log-rank p = 0.014). Multivariable Cox regression analysis showed that chronic kidney disease (aHR 1.89, 95% CI 1.19-3.01, p < 0.01), non-Killip class 1 (aHR 1.90, 95% CI 1.01-3.57, p = 0.047) and CR participation (aHR 0.57, 95% CI 0.36-0.90, p = 0.015) were independent predictors of MACE. Conclusions: Comprehensive CR after PCI in patients with MI effectively reduces the occurrence of MACE, regardless of their exercise capacity. We should also actively encourage patients with low exercise capacity to participate in comprehensive CR.