Introduction: Cardiac rehabilitation programs (CRP) after ST elevation myocardial infarction (STEMI) provide patients exercise, optimal medical treatment, education and counselling. Our objective was to analyze the functional impact of a CRP in this population and identify subgroup with more or less benefit.
Methods: We made an observational retrospective study including severe LSVD patients after STEMI admitted to a CRP in our institution between 2006 and 2014. Physical training, nutritional education, optimal medical treatment and medical counselling were supplied according to the CRP for 8 to 10 weeks. Left ventricular systolic function and functional capacity were tested before and after the CRP in accordance with the NYHA Functional Classification, besides a treadmill stress test (TST). Exercise capacity was reported in terms of estimated metabolic equivalents of task (METs).
Results: A total of 156 patients were included in our study, mean age 56.19 ± 12,22 years, male 90.4%. Prevalence of hypertension was 50.6%, diabetes 27.9%, dyslipidemia 55.8%, obesity 28.1%, current smoker 59%, chronic kidney disease (CKD) 5.1%, chronic obstructive pulmonary disease (COPD) 6.5% and cerebrovascular disease (CD) 1.9%. The NYHA class previous CRP was I 46.5%, II 43.7%, III 9.9%. Mean initial left ventricular ejection fraction (LVEF) was 29.93 ± 5.14%. As to TST results before the CRP, medium METs were 6.46 ± 2.98 and 5.9 ± 2,69 minutes was the mean exercise time (ET). After CRP, LVEF was 42.32 ± 10.52% (LVEF improvement compare to baseline, 12.41 ± 9.52%; p < 0.001). The NYHA class was I 79.7%, II 19.5%, III 0.8%. Medium METs were 10.04 ± 2.98 (METs improvement 3.52 ± 2.06; p < 0.001) and mean ET was 8.65 ± 2.50 minutes (ET improvement 2.62 ± 2.90 minutes; p < 0.001). We did not find statistically significant differences in functional capacity or LVEF improvement according to sex, age, cardiovascular risk factors profile, CKD, COPD or CD.
Conclusions: Severe LVSD patients enrolled in a CRP after suffering an STEMI improve functional capacity and LVEF regardless their previous cardiovascular risk factors profile, CKD, COPD and CD.