3-week rehabilitation after acute myocardial infarction in young patients is associated with better risk factor control and lower event rates

Hatim Kerniss (Bremen)1, L. A. Mata Marín (Bremen)1, K. Clemens (Bremen)1, A. Seidel-Sarpong (Bremen)1, C. Litfin (Bremen)1, S. Alo (Bremen)1, S. Rühle (Bremen)1, J. Schmucker (Bremen)1, R. Osteresch (Bremen)1, A. Fach (Bremen)1, R. Hambrecht (Bremen)1, H. Wienbergen (Bremen)1

1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland


Cardiovascular prevention in young patients with myocardial infarction (MI) is of extraordinary importance due to long life expectancy and socioeconomic responsibilities of patients. It was the purpose of the present study to investigate if 3-week rehabilitation after acute MI in young patients is associated with better long-term risk factor control and lower cardiovascular event rates.
All consecutive patients ≤ 45 years with MI who were admitted to an overregional heart center between 2015 and 2021 were included and stratified into participation in a 3-week rehabilitation (in-patient or out-patient) after acute MI versus no participation. Risk factor control and cardiovascular event rates were analyzed during long-term follow-up. 
Out of n=291 young patients with MI, 73.5% (n=214) participated in a 3-week rehabilitation. There were no significant differences between participants and non-participants in terms of infarct severity (EF, number of coronary artery disease, Killip classification, CK-max levels), obesity rates (40.2% vs. 42.3%, p=0.74), active smoking (81.2% vs. 84.6%, p=0.57), diabetes mellitus (18.2% vs. 23.1%, p=0.35) or LDL cholesterol levels (125 ± 46 mg/dl vs. 129 ± 50 mg/dl; p=0.59). 
At one-year follow-up, rehabilitation participants had significantly lower rates of active smoking (38.3% vs. 55.1%, p=0.01), physical inactivity (69.6% vs. 83.3%, p=0.02), diabetes mellitus (20.5% vs. 30.1%, p=0.01) and LDL cholesterol levels (80 ± 37 mg/dl vs. 93 ± 49 mg/dl; p=0.01) compared to non-participants. During long-term follow-up (Figure 1) rehabilitation participants had a significantly lower rate of cardiovascular events (cardiovascular death, stroke or acute coronary syndrome) compared to non-participants with 17.3% versus 29.5% events (HR 0.57, p=0.03).
Young patients with MI that participated in a 3-week rehabilitation after acute MI had better risk factor control and lower event rates during long-term follow-up. The study results emphasize the impact of lifestyle modification and medical prevention in secondary prevention after MI in young patients. 
Data on prognostic effects of long-term prevention programs after 3-week rehabilitation are currently lacking; however, the ongoing multicenter NET-IPP trial will close this evidence gap.

Figure 1: Long-term follow-up in n=291 patients ≤45 years with MI, stratified into participation in a 3-week rehabilitation versus no participation.
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