Results of outpatient cardiac rehabilitation with the includion of physical training in patients after acute coronary syndrome with a yearly follow-up

Abstract

The aim – to evaluate the results of clinical, instrumental and laboratory indicators, including the level of PCSK9, before and after physical activity with a symptom-limited test on a bicycle ergometer in patients after acute coronary syndrome (ACS) / myocardial infarction (MI) and ACS / unstable angina (UA) and interventional interventions on coronary vessels, as well as outpatient cardiac rehabilitation with the involvement of physical training in dynamics during 1 year of observation.
Materials and methods. The study included 101 patients (all men) with ACS/STEMI and ACS/US (unstable angina) aged 28 to 77 years (Me age was 56 (quartile 50–65) years). All patients underwent coronary angiography. 74 patients underwent urgent stenting of the infarct-causing artery, 16 – delayed stenting, 8 patients – coronary angioplasty, 5 patients with multivessel disease – coronary artery bypass grafting. All patients were divided into two groups using the «envelope method»: the 1st group (20 people) – patients included in the physical training program (PT), which was carried out in an outpatient setting, on a bicycle ergometer and was carried out for 2-2.5 months – a total of 24–30 sessions, and the 2nd group of 81 patients was the control group. Patients of the 2nd group underwent rehabilitation without PT in outpatient conditions with the inclusion of a complex kinesiotherapy and distance walking, recommended upon discharge from the hospital. All patients were observed for a year, three times a year (10–12 days from the development of ACS, after 3 months and after 12 months) were performed: symptom-limited test on a bicycle ergometer, echocardiography, biochemical studies, including a lipidogram, as well as determination of the level of PCSK9 before and after physical exertion on a bicycle ergometer.
Results and discussion. Patients after the physical trainig during the symptom-limited test 3 months after ACS (acute coronary syndrome) demonstrated a higher level of work performed (A) (45 kJ vs 27 kJ, p=0.000064) and better hemodynamic support for its performance (∆PD/A – 2.13 un. in the PT group vs 2.54 un. in the control group (p=0.034263)) and a greater increase in LV EF (56 % in the PT group vs 53 % in the control group, p=0.036793), with the results maintained for a year. During three visits, only patients in group 1 (PT) had a statistically significant decrease in PCSK9 levels after the exercise test (ET) (from 405 to 353 ng/ml, p=0.035693 after 3 months, and from 372 to 312 ng/ml, p=0.027993 after a year), compared with patients in the control group (from 240 to 225 ng/ml, p=0.60018 – after 3 months and from 332 to 296 ng/ml, p=0.224917). The obtained data indicate the effectiveness of outpatient cardiac rehabilitation of patients after ACS with the inclusion of physical training and demonstrate a decrease in PCSK9 levels, which is considered an independent factor in the progression of atherosclerosis.
Conclusions. The outpatient cardiac rehabilitation program with the inclusion of PT sessions on a bicycle ergometer for 2–2.5 months in patients after ACS contributed to a better restoration of tolerance to physical activity, an increase in LV EF. It was determined that only in the physical training group was a statistically significant decrease in the level of PCSK9 observed during the exercise test, which indicates one of the mechanisms of the positive effect of physical training on the process of preventing the progression of coronary atherosclerosis.