Cardiac biomarker release following myocardial infarction: role of exercise

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMw Background Regular exercise training is an important factor in the prevention of myocardial infarction (MI) and engagement in exercise training is associated with reduced mortality risks following MI. However, the relation between exercise engagement and the magnitude of cardiac biomarker release following MI have not been investigated yet. Purpose To explore the relation between exercise engagement and cardiac biomarker release following a MI. We hypothesized that exercise engagement is associated with lower peak concentrations of cardiac biomarker following MI compared to their non-exercising peers. Methods In this cohort study, we recruited hospitalised MI patients and retrospectively assessed the amount of exercise engagement in the seven days preceding MI onset. Exercise levels were evaluated using a validated questionnaire during a bedside interview. Patients were assigned to the exercise group if they performed any moderate-to-vigorous intensity exercise in the week prior MI and to the control group if they did not perform exercise. Maximum concentrations of cardiac troponin T (max-cTnT), in ng/mL, and creatine kinase (max-CK), in U/L, during hospital stay were extracted from digital health records. Both cardiac biomarker data were classified into 3 groups; 0-499 (small), 500-1499 (medium), and ≥1500 (large). The association of exercise engagement on post-MI cardiac biomarkers was analysed using the Mann-Witney U-test and the chi-square test. Results We included 200 MI patients (male: 64.5%, age 65.2 ± 10.4, 49% STEMI, 51% NSTEMI) of which 39 (19.5%) patients were allocated to the exercise group and 161 (80.5%) to the control group. No differences in time from symptom onset to coronary angiography (565 [136-2048] min versus 581 [135-2059] min, p=0.767) or incident hospital-based major adverse cardiac events (5.6% vs 5.1%, p=0.910) was found across groups. Albeit lower, those engaged in exercise do not significantly differ from controls in post-MI max-cTnT concentrations (788 [326-1344] ng/mL vs 1197 [340-3590] ng/mL, p=0.103) and max-CK concentrations (382 [211-744] U/L vs 564 [203-1374] U/L, p=0.147). The magnitude of max-cTnT was more often classified as ‘small’ in the exercise versus control group (x² (2) = 7.71, p=0.021), whilst a trend was found for max-CK levels (x² (2) = 4.97, p=0.083). Conclusion Engagement in exercise prior to MI may be associated with lower cardiac biomarker release. This could add novel insights into the potential protective effects of exercise engagement in the severity of MI.