Cardiac Rehabilitation of Patients with Acute ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in a Han Population in Northern China: A Prospective Cohort Study

Jingru Ma,1 Yuling Tai,2 Mengmeng Fan,3 Zhansheng Wang4 1Department of Cardiology, The Second Affiliated Hospital, Shenyang Medical College, Shenyang, 110035, People’s Republic of China; 2Department of Cardiology, Tongliao City Hospital, Tongliao, 028000, People’s Republic of China; 3Department of Cardiology, Xinxiang Central Hospital, Xinxiang, 453000, People’s Republic of China; 4Department of Cardiology, Fourth People’s Hospital of Shenyang, Shenyang, 110034, People’s Republic of ChinaCorrespondence: Jingru MaThe Second Affiliated Hospital of Shenyang Medical College, No. 64 Qishan West Road, Huanggu District, Shenyang, 110035, Liaoning Province, People’s Republic of ChinaTel + 86-18002453999Email majingru00@126.comBackground: Cardiac rehabilitation (CR) has been associated with improved cardiac function in cardiovascular diseases. Our aim was to explore the factors associated with cardiac function and CR.Methods: This prospective cohort study had 473 STEMI patients admitted for primary percutaneous coronary intervention (PCI) who were divided into a CR group (group A, n = 104) and a non-CR group (group B, n = 369) based on whether they could complete CR. Patients’ clinical features, such as age, hyperlipidemia, family history of premature coronary heart disease (FHPCHD), smoking history, body mass index (BMI, kg/m2), number of diseased vessels, arrhythmia during PCI, N-terminal pro–B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF) and major adverse cardiac events (MACEs) at 6 months after PCI were compared. Then, the clinical characteristics of patients were further analyzed according to those with MACEs (n = 78) and those without MACEs (n = 395).Results: After CR of 6 months, NT-proBNP levels (p = 0.027), 6-MWD (meter, P = 0.000), LVEF (P = 0.000) were significantly improved in group A compared to group B, but not for SMWA (P = 0.875). Multivariate analysis indicated that even though patients in group A (OR 3.06, 95% CI 1.132– 8.274, p = 0.03) have a higher incidence of hyperlipidemia, their MACEs (OR 0.191, 95% CI 0.038– 0.961, p = 0.05) at 6 months were significantly lower than in group B, mainly because the average patient low age (< 65 years, OR 0.917, 95% CI 0.859– 0.979, p = 0.01) and significant improvement of 6-MWD (OR 7.999, 95% CI 4.342– 14.737, P = 0.00) and the LVEF at 6 months (OR 1.112, 95% CI 1.072– 1.154, p = 0.00). Further analysis based on the MACES outcomes showed that there were 6 factors associated with the occurrence of MACEs, they were age > 65 years (OR 1.032, 95% CI 1.009– 1.009, p = 0.007), smoking history (OR 0.485, 95% CI 0.238– 0.989, p = 0.046), education level (OR 2.646, 95% CI 1.370– 5.108, p = 0.004), 6-MWD (OR 1.688, 95% CI 1.104– 2.811, p = 0.044), LVEF (OR 0.958, 95% CI 0.926– 0.991, p = 0.013) and CR (OR 6.271, 95% CI 2.236– 17.590, p = 0.000).Conclusion: CR, including exercise rehabilitation, is a beneficial option to reduce MACEs in STEMI patients treated with primary PCI.Keywords: rehabilitation, ST-elevation myocardial infarction, percutaneous coronary intervention, major adverse cardiac events