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Prognostic impact of cardiac rehabilitation program after STEMI

Session Poster session 3

Speaker Ines Silveira

Event : ESC Congress 2016

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : I Silveira (Porto,PT), MJ Sousa (Porto,PT), B Brochado (Porto,PT), R B Santos (Porto,PT), M Trepa (Porto,PT), A Barreira (Porto,PT), S Magalhaes (Porto,PT), J Preza Fernandes (Porto,PT), A Luz (Porto,PT), S Torres (Porto,PT)

Authors:
I. Silveira1 , M.J. Sousa1 , B. Brochado1 , R.B. Santos1 , M. Trepa1 , A. Barreira1 , S. Magalhaes1 , J. Preza Fernandes1 , A. Luz1 , S. Torres1 , 1Hospital Center of Porto, Cardiology - Porto - Portugal ,

Citation:
European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 542

Purpose: Exercise-based cardiac rehabilitation programs (CRP) have gained relevance in secondary prevention. However, participation in these programs remains far below the desirable. The purpose of this study was to determine the prognostic impact of CRP after ST Elevation Acute Myocardial Infarction (STEMI).

Method: Retrospective study, including patients who underwent primary percutaneous coronary intervention for STEMI, between January 2008 and December 2014. We compared patients incorporated in a 3-months in-hospital CRP (n=345) with patients that did not participate in the program (Non-CRP) (n=295). Clinical characteristics, survival and major cardiac events (MACE - (death, stroke, re-infartion and target vessel revasculatization))-free survival rates 30 days to one year after STEMI were studied.

Results: We analyzed 640 pts, mean age 62±13 years, 75% male. 54% participated in CRP. This group included younger pts (58±11 vs 66±13 years, p<0.001), higher proportion of men (81% vs 68%, p<0.001) and smokers (64% vs 42% p<0.001), higher creatinine clearance (96.7±34.1 vs 81.1±35.7 ml/min/1.73m2 p<0.001) and less diabetic pts (21% vs 28% p=0.023). The CRP group of pts had, also, less multivessel coronary disease (51% vs 60%, p=0.009), lower GRACE score (198.8±51.1 vs 217.8±58.2 p<0.001) and Syntax score (16.7±8.3 vs 19.4±10.6 p<0.001) and shorter hospital stay (7.1±4.6 vs 9.2±7.7 days), with same proportion of pts with moderate to severe left ventricular dysfunction (35,7%). Survival and MACE free survival rates from 30 days to one year after STEMI were significantly higher in the CRP group (Survival rates from 30 days to one year: 98.5% vs 89.6%, p<0.001; MACE free survival rates from 30 days to one year: 87.4% vs 75.4%, p<0.001). After multivariable analysis, CRP remained an independent predictor of survival and MACE free survival.

Conclusion: CRP was an independent predictor of prognosis, being associated with a significant reduction in mortality and MACE after STEMI. Therefore a larger number of pts should be encouraged to participate in these programs.

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