Abstract 20572: Is Active Participation in Cardiac Rehabilitation Associated With Better Long-Term Prognosis in Patients After Acute Myocardial Infarction Even in the Primary PCI Era?
Introduction: Although the short-term prognosis of patients with acute myocardial infarction (AMI) has been improved in the era of primary coronary intervention (PCI), the determinants of long-term prognosis of AMI patients who participated in cardiac rehabilitation (CR) are unknown.
Methods: We studied a total of 1836 consecutive AMI patients who entered our CR program in 1999-2014. Follow-up data for all-cause death and hospitalization for any reasons were obtained in 1800 patients (follow-up rate 98.0%). Patients were divided into two groups according to occurrence of all-cause death or any hospitalization: No-event group (n=910) and Event group (n=890).
Results: As a whole, the studied patients were relatively young (average age 64±11years) and had preserved left ventricular ejection fraction (LVEF 45±10%). During the mean follow-up period of 2224±1504days, there were 84 deaths (32 cardiac, 52 non-cardiac deaths) and 881 hospitalizations (623 cardiac, 258 non-cardiac hospitalizatins) in 890 patients. Compared with No-event group, Event group was significantly older (No-event group 63 vs Event group 65 years, p<0.001), and had lower LVEF (46 vs 44%, p<0.001), longer days from admission to CR entry (10.3 vs 13.0 days, p<0.001), lower baseline peak oxygen uptake (peak VO2, 77.0 vs 73.9%, p<0.001), higher prevalence of diabetes (37 vs 45%, p<0.001), and higher rate of prescription of diuretics and lower statin use, but showed similar rates of prescription of ACEI/ARB and beta-blockers and similar increases in peak VO2 after CR (10.2 vs 9.3%, NS). On multivariate Cox proportional hazard analysis, independent predictors of the event-free survival were younger age (p<0.001), female sex (p<0.001), higher baseline peak VO2 (in quintile, p<0.001), more frequent CR session attendance (in quintile, p<0.05), a greater increase in peak VO2 in CR (in tertile, p=0.001), non-diabetes (p<0.05), and statin use (p<0.001).
Conclusions: More frequent CR session attendance and a greater increase in peak VO2 in CR are associated with better event-free survival in post-AMI patients, suggesting that, even in the primary PCI era, active participation in CR may favorably contribute to better long-term prognosis.
Author Disclosures: Y. Goto: None. M. Nakanishi: None. T. Arakawa: None. L. Kumasaka: None. K. Nakao: None. M. Fujino: None. K. Nishihira: None. Y. Kataoka: None. S. Fukui: None. M. Yanase: None. T. Noguchi: None. S. Yasuda: None. H. Ogawa: Other Research Support; Modest; Eisai Co.,Ltd.. Other Research Support; Significant; Abbott Vascular Jaoan, Bayer Yakuhin, Ltd., Boehringer Ingelheim Japan, Boston Scientific Japan K.K., Chugai Pharmaceutical Co.,Ltd., Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Fukuda Denshi Co., Ltd., Johnson & Johnson, Medtronic Japan Co., Ltd., Mitsubishi Tanabe Pharma, Mochida Pharmaceutical Co., Ltd., Nihon Kohden, Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co, Ltd, Sanofi K.K., Takeda Pharmaceutical Co., Ltd., Teijin, Teijin Pharma Co., Ltd, Terumo. Honoraria; Modest; AstraZeneca K.K., Eisai Co.,Ltd., Otsuka Pharmaceutical Co, Ltd, Takeda Pharmaceutical Co., Ltd., Teijin Pharma Co., Ltd. Honoraria; Significant; Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd., MSD K.K..
- © 2016 by American Heart Association, Inc.