Abstract
BackgroundThe purpose of this study was to analyze cardiopulmonary fitness in Phase I cardiac rehabilitation on the prognosis of patients with ST-Elevation Myocardial Infarction (STEMI) after percutaneous coronary intervention (PCI).MethodsThe study enrolled a total of 499 STEMI patients treated with PCI between January 2015 and December 2015. Patients were assigned to individualized exercise prescriptions (IEP) group and non-individualized exercise prescriptions (NIEP) group according to whether they accept or refuse individualized exercise prescriptions. We compared the incidence of major cardiovascular events between the two groups. IEP group were further divided into two subgroups based on prognosis status, namely good prognosis (GP) group and poor prognosis (PP) group. Key cardio-pulmonary exercise testing (CPX) variables that may affect the prognosis of patients were identified through comparison of the cardio-respiratory fitness (CRF).ResultsThere is no significant difference in the incidence of cardio-genetic death, re-hospitalization, heart failure, stroke, or atrial fibrillation between the IEP and the NIEP group. But the incidence of total major adverse cardiac events (MACE) was significantly lower in the IEP group than in the NIEP group (P = 0.039). The oxygen consumption (VO2) at ventilation threshold (VT), minute CO2 ventilation (E-VCO2), margin of minute ventilation carbon dioxide production (△CO2), rest partial pressure of end-tidal carbon dioxide(R-PETCO2), exercise partial pressure of end-tidal carbon dioxide(E-PETCO2) and margin of partial pressure of end-tidal carbon dioxide(△PETCO2) were significantly higher in the GP subgroup than in the PP subgroup; and the slope for minute ventilation/carbon dioxide production (VE/VCO2) was significantly lower in GP subgroup than in PP subgroup (P = 0.010). The VO2 at VT, VE/VCO2 slope, E-VCO2, △CO2, R-PETCO2, E-PETCO2 and margin of partial pressure of end-tidal carbon dioxide CO2 (△PETCO2) were predictive of adverse events. The VO2 at VT was an independent risk factor for cardiovascular disease prognosis.ConclusionsIndividualized exercise prescription of Phase I cardiac rehabilitation reduced the incidence of cardiovascular events in patients with STEMI after PCI. VO2 at VT is an independent risk factor for cardiovascular disease prognosis, and could be used as an important evaluating indicator for Phase I cardiac rehabilitation.
Highlights
The purpose of this study was to analyze cardiopulmonary fitness in Phase I cardiac rehabilitation on the prognosis of patients with ST-Elevation Myocardial Infarction (STEMI) after percutaneous coronary intervention (PCI)
No significant difference in demographics was found between the individualized exercise prescriptions (IEP) group and the non-individualized exercise prescriptions (NIEP) group
We found that Oxygen consumption (VO2) at ventilation threshold (VT), VE/Carbon dioxide production (VCO2) slope, Exercise carbon dioxide production (E-VCO2), △Margin of minute ventilation carbon dioxide production (CO2), R-Rest partial pressure of end-tidal carbon dioxide (PETCO2), E-PETCO2 and △PETCO2 to be predictive of adverse events, and the optimal cut-off point was 10.5 ml/ kg/min, 33.4, 0.635 L/min, 0.345 L/min, 30.5 mmHg, 32.5 mmHg, and 2.5 mmHg, respectively (Figs. 2 and 3, Table 6)
Summary
The purpose of this study was to analyze cardiopulmonary fitness in Phase I cardiac rehabilitation on the prognosis of patients with ST-Elevation Myocardial Infarction (STEMI) after percutaneous coronary intervention (PCI). Acute STEMI is a leading cause of mortality and morbidity globally. Medication, coronary artery bypass grafting, and percutaneous coronary intervention (PCI) can reduce the morbidity and mortality in patients with STEMI [2, 3]. Medication is a basic treatment for patients before/after PCI. Compared with coronary artery bypass grafting, PCI provides an effective treatment for coronary artery stenosis. PCI operation may lead to coronary spasm, endothelial cell injury, and even restenosis or thrombus; a poor prognosis may still exist in patient with STEMI after PCI [4]
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