Clinical Value of Different Cardiac Rehabilitation Programs Applied to Patients with Acute Myocardial Infarction Early after Percutaneous Coronary Intervention

Abstract

Objective: To investigate the clinical value and impact of cardiac rehabilitation programs applied to patients with acute myocardial infarction (AMI) early after percutaneous coronary intervention (PCI).

Methods: The enrolled participants were 90 cases of AMI who received PCI in Shaoxing People′s Hospital from January 2014 to May 2016. They were randomized into traditional routine group, traditional strengthening group and new optimization group with 30 cases in each. The cardiac rehabilitation program for traditional routine group was developed based on the rehabilitation program applied to patients one week after emergency PCI included in 2006 Chinese Cardiac Rehabilitation Programs after PCI, mainly consisting of simple forms of exercise such like walking. Both the traditional strengthening group and new optimization group received the cardiac rehabilitation program developed based on the rehabilitation program applied to patients after selective PCI included in 2006 Chinese Cardiac Rehabilitation Programs after PCI. In addition, the new optimization group received the early-applied, personalized and accurate cardiac rehabilitation program developed in accordance with the latest concepts in cardiac rehabilitation received by Avans University, UMC St RAdboud, Queen Elizabeth Hospital and other hospitals in Hong Kong. The traditional strengthening group and new optimization group had greater basal activities and total activities than the traditional routine group. The intervention period for all the groups was six months. Color Doppler echocardiography was performed in the groups immediately after PCI (before the cardiac rehabilitation intervention) and six months after the starting of cardiac rehabilitation program (after the cardiac rehabilitation intervention), respectively for measuring the left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and wall motion score index (WMSI). Levels of serum tumor necrosis factor-alpha (TNF-α), nitric oxide (NO), endothelin 1 (ET-1) and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured before and after the cardiac rehabilitation intervention. The incidences of malignant arrhythmia, angina pectoris, heart failure and sudden death during the cardiac rehabilitation were observed.

Results: No significant differences in LVEF, LVESV, LVEDV, WMSI, TNF-α, NO, ET-1 and sVCAM-1 levels were found among the three groups before the cardiac rehabilitation (P＞0.05). After the cardiac rehabilitation intervention, the WMSI was lower in the traditional strengthening group than that in the routine traditional group, LVEF was higher in the new optimization group than that in the routine traditional group and traditional strengthening group, WMSI was lower in the new optimization group than that in the routine traditional group and traditional strengthening group (P＜0.05). LVEF was higher after the cardiac rehabilitation intervention than that before the cardiac rehabilitation intervention in the three groups (P＜0.05). After the cardiac rehabilitation intervention, the levels of TNF-α, ET-1 and sVCAM-1 were lower in the traditional strengthening group than those in the routine traditional group, the level of NO was higher in the traditional strengthening group than that in the routine traditional group, the levels of TNF-α, ET-1 and sVCAM-1 were lower in the new optimization group than those in the routine traditional group and traditional strengthening group, the level of NO was higher in the new optimization group than that in the routine traditional group and traditional strengthening group (P＜0.05). The levels of TNF-α, ET-1 and sVCAM-1 were lower, but the level of NO was higher after the cardiac rehabilitation intervention than that before the cardiac rehabilitation intervention in the three groups (P＜0.05). During the cardiac rehabilitation intervention, the incidence of malignant arrhythmia differed significantly among the three groups (P＜0.05); three groups had similar incidences of angina pectoris and heart failure (P＞0.05); no sudden death occurred in all groups.

Conclusion: Cardiac rehabilitation training applied to patients with AMI early after PCI can obviously improve the cardiac function and prognosis. The humanitarian cardiac rehabilitation program based on personal conditions used in the new optimization group can achieve the optimal effect of rehabilitation, which can also protect the cardiac function to the utmost and improve the prognosis tangibly.