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


CONCLUSIONS
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.
Jünger
Claus
C
Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany.
Rauch
Bernhard
B
Schneider
Steffen
S
Liebhart
Nadine
N
Rauch
Geraldine
G
Senges
Jochen
J
Bestehorn
Kurt
K
D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000534:rehabilitation*; D011379:Prognosis; D011446:Prospective Studies