Article

Although numerous studies have reported that cardiac rehabilitation
(CR) is associated with reduced mortality after myocardial infarction, less is
known about its association with mortality after percutaneous coronary
intervention. METHODS : We performed a retrospective analysis of data
from a prospectively collected registry of 2395 consecutive patients who
underwent percutaneous coronary intervention in Olmsted County, Minnesota, from
1994 to 2008. The association of CR with all-cause mortality, cardiac mortality,
myocardial infarction, or revascularization was assessed with 3 statistical
techniques: propensity score--matched analysis (n=1438), propensity score
stratification (n=2351), and regression adjustment with propensity score in a
3-month landmark analysis (n=2009). During a median follow-up of 6.3 years, 503
deaths (199 cardiac), 394 myocardial infarctions, and 755 revascularization
procedures occurred in the study subjects. Participation in CR, noted in 40% (964
of 2395) of the cohort, was associated with a significant decrease in all-cause
mortality by all 3 statistical techniques (hazard ratio, 0.53 to 0.55; P<0.001).
A trend toward decreased cardiac mortality was also observed in CR participants;
however, no effect was observed for subsequent myocardial infarction or
revascularization. The association between CR participation and reduced mortality
rates was similar for men and women, for older and younger patients, and for
patients undergoing elective or nonelective percutaneous coronary intervention.
CONCLUSIONS: We found that CR participation after percutaneous coronary
intervention was associated with a significant reduction in mortality rates.
These findings add support to published clinical practice guidelines, performance
measures, and insurance coverage policies that recommend CR for patients after
percutaneous coronary intervention.

Langue : ANGLAIS

Tiré à part : OUI