Assessment of exercise tolerance in patients with acute myocardial infarction after angioplasty in a multidisciplinary hospital

Abstract

Currently, according to the St. Petersburg CardioRegistry since 2016, which includes the entire volume of medical care provided to all patients with acute coronary syndrome in all medical institutions of St. Petersburg, there is no data on the performance of exercise tests to assess exercise tolerance (ET) before the end of the inpatient treatment phase. Assessment of ET before discharge from the hospital or transfer to a rehabilitation department is important not only for evaluating the effectiveness of endovascular treatment but also for effective and safe cardiac rehabilitation of patients after acute myocardial infarction (AMI) at all stages. Predicting the construction of personalized cardiac rehabilitation programs based on different ET in patients with varying degrees of myocardial revascularization and left ventricular contractile function will be the basis for recommendations on early effective rehabilitation after revascularization surgery. These programs will undoubtedly determine the success of rehabilitation measures at subsequent stages for restoring the health and ability to work of patients, as well as reducing the risks of recurrent coronary events. The aim of the work is to evaluate the safety of using exercise tests in the early stages of AMI treatment and to determine the difference in ET in patients with varying degrees of myocardial revascularization and left ventricular contractile function for the subsequent construction of personalized cardiac rehabilitation programs. Materials and methods. We examined 173 patients urgently admitted to the regional vascular center with AMI (Q-AMI – 95 patients, non-Q-AMI – 78 patients) aged 38 to 79 years (average age 59±11 years). Patients underwent coronary angiography, emergency angioplasty and coronary artery stenting, and echocardiography to assess left ventricular ejection fraction (LVEF). Patients were divided into groups depending on the completeness of myocardial revascularization and LVEF. Upon discharge from the hospital, transfer to a rehabilitation department or a specialized sanatorium (average hospitalization duration was 11 days), stress tests were performed: a six-minute walk test (6MWT), and bicycle ergometry test (BET) on a vertical or horizontal bicycle ergometer (Schiller), which determined ET. The results of the work showed that with proper clinical selection of patients, taking into account the severity of cardiovascular diseases and concomitant somatic pathology, with an assessment of the risks of complications, performing stress tests by qualified medical staff of a multidisciplinary hospital before discharge is a safe method of functional diagnosis. Significant differences in ET in patients in different groups were identified, which allows for a personalized approach in the early inpatient stage of cardiac rehabilitation, including individual metered physical activity.

Conclusion: The completeness of myocardial revascularization and LVEF are among the significant factors affecting ET in patients with AMI after endovascular surgery and should be taken into account when designing personalized cardiac rehabilitation programs. A personalized approach based on clear clinical, laboratory, and instrumental data will improve the cardiac rehabilitation system for patients after AMI in general.