Clinical outcomes in myocardial infarction and multivessel disease after a cardiac rehabilitation programme: Partial versus complete revascularization

Arch Cardiovasc Dis. 2017 Apr;110(4):234-241. doi: 10.1016/j.acvd.2016.09.007. Epub 2017 Jan 9.

Abstract

Background: Current guideline recommendations encourage culprit vessel only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, recent studies have shown a better clinical outcome in patients who receive multivessel PCI.

Aim: To measure and compare clinical outcomes between partial revascularization (PR) versus complete revascularization (CR) in patients with STEMI and multivessel disease who underwent a cardiac rehabilitation programme.

Methods: We retrospectively reviewed the medical records of 282 patients with STEMI and multivessel disease who received PR or CR and were subsequently enrolled in a cardiac rehabilitation programme between July 2006 and November 2013 at La Paz University Hospital. The incidences of cardiovascular events, new PCI, hospital admissions for cardiovascular reasons and mortality were compared between the PR and CR groups.

Results: Overall, 143 patients received PR and 139 received CR. Baseline characteristics were similar in both groups, except for mean age (59.3 vs. 56.7 years; P=0.02), diabetes mellitus prevalence (34.3% vs. 20.1%; P=0.01) and number of arteries with stenosis (2.6 vs. 2.3; P=0.001). During the mean follow-up of 48.0±25.9 months, a cardiovascular event occurred in 23 (16.1%) PR patients and 20 (14.4%) CR patients, with no statistically significant differences in the early (hazard ratio: 0.61, 95% confidence interval: 0.19-1.89) or late (hazard ratio: 1.40, 95% confidence interval: 0.62-3.14) follow-up periods. Cox regression, adjusted for age, sex, presence of diabetes mellitus and number of affected coronary vessels, showed no difference in new cardiovascular event risk.

Conclusions: There were no statistical differences in clinical outcomes between PR and CR among patients who received cardiac rehabilitation.

Keywords: Angioplastie; Angioplasty; Coronaropathie; Coronary artery disease; Infarctus du myocarde; Myocardial infarction; Prognosis; Pronostic; Rehabilitation; Réadaptation.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cardiac Rehabilitation / adverse effects
  • Cardiac Rehabilitation / methods*
  • Cardiac Rehabilitation / mortality
  • Chi-Square Distribution
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy*
  • Coronary Stenosis / complications
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / mortality
  • Coronary Stenosis / therapy*
  • Female
  • Hospitals, University
  • Humans
  • Kaplan-Meier Estimate
  • Linear Models
  • Male
  • Medical Records
  • Middle Aged
  • Patient Readmission
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / methods*
  • Percutaneous Coronary Intervention / mortality
  • Proportional Hazards Models
  • Retreatment
  • Retrospective Studies
  • Risk Factors
  • ST Elevation Myocardial Infarction / diagnostic imaging
  • ST Elevation Myocardial Infarction / etiology
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / therapy*
  • Severity of Illness Index
  • Spain
  • Time Factors
  • Treatment Outcome