Aims Cardiovascular rehabilitation (CR) improves aerobic capacity and quality of life in patients after myocardial infarction (MI). The aim was to examine the associations between exercise capacity improvement and different clinically relevant cardiovascular events. Methods and results This was a registry-based study of post-MI patients, referred to CR. All patients were submitted to exercise testing before and after CR (36 sessions, 2–3 times/week, and combined exercise). Patients were divided into two groups, based on the difference in exercise capacity before and after the CR programme with the cut-off of two metabolic equivalents (METs) improvement. We assessed the correlation between the extent of exercise capacity improvement and the following cardiovascular events: major adverse cardiac events (MACE), cardiovascular-related hospitalizations, and unplanned coronary angiography. A total of 499 patients were included (mean age 56 ± 10 years, 20% women). Both groups significantly improved in terms of exercise capacity, natriuretic peptide levels, resting heart rate, and resting diastolic pressure; however, lipid status significantly improved only in patients with ≥2 METs difference in exercise capacity. A total of 13.4% patients suffered MACE (median follow-up 858 days); 21.8% were hospitalized for cardiovascular reasons (median follow-up 791 days); and 19.8% had at least one unplanned coronary angiography (median follow-up 791 days). Exercise capacity improvement of ≥2 METs was associated with lower rates of MACE, cardiovascular hospitalizations, and unplanned coronary angiography in all examined univariate and multivariate models. Conclusion This study has shown that exercise improvement of ≥2 METs is associated with a significant decrease in MACE, cardiac hospitalizations, and unplanned coronary angiography.
Background Cardiac rehabilitation after myocardial infarction improves cardiovascular health and quality of life. However, data on long-term prognostic impact of surrogate rehabilitation parameters–such as exercise capacity improvements–remain scarce. Purpose To assess the independent prognostic impact of exercise capacity improvement over the course of outpatient cardiac rehabilitation after myocardial infarction. Methods Consecutive patients undergoing outpatient cardiac rehabilitation (3-times weekly for 12 weeks) after a myocardial infarction at a university centre were included. Exercise testing was performed at inclusion and after completion of the rehabilitation programme, with exercise capacity improvement defined as ≥2 MET increase over the course of the programme. Clinical data and risk factors were systematically collected, and patients were followed up for a minimum of 2 years. Kaplan-Meier curves and a multivariate Cox proportional hazard model were constructed for prediction of events (defined as a composite of incident cardiovascular death, re-infarction and coronary revascularsiation), with age, sex, LDL-cholesterol levels and body mass index as co-variates. Results A total of 409 patients were included (20% women). Exercise capacity and expected exercise performance were significantly improved after cardiac rehabilitation programme (6.6 to 9.5 METs, p<0.001, and 82 to 117%, p<0.001, respectively). After a median follow-up of 6.5 years, 93 patients experienced an event. Exercise capacity improvement of ≥2 METs was associated with reduced event rates (Figure 1), retaining statistical significance even after adjusting for age, sex, LDL-cholesterol and body mass index (HR 0.485, 95% CI 0.285–0.824). Kaplan-Meier curve Conclusion Improvement of exercise performance over the course of outpatient cardiac rehabilitation is an independent predictor of prognosis after a myocardial infarction, with improvements of ≥2 METs associated with a 50% reduction in events.
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