Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study.
Résumé
Background. - Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality.
Objective. - To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI).
Methods. - Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model.
Results. - At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5 years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs. >= 60 years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40).
Conclusion. - After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit. (C) 2015 Elsevier Masson SAS. All rights reserved.
Mots clés
Acute myocardial infarction
Cardiac rehabilitation
Infarctus du myocarde aigu
Infarctus du myocarde avec sus-décalage du segment ST
Infarctus du myocarde sans sus-décalage du segment ST
Mortality
Mortalité
Non–ST-segment elevation myocardial infarction
Réadaptation cardiaque
ST-segment elevation myocardial infarction