Comprehensive medical rehabilitation program after percutaneous coronary intervention for acute myocardial infarction in patients with coronary heart disease and arterial hypertension: efficacy, safety, and the results of remote monitoring

Objective. To evaluate the clinical effects and safety of an integrated rehabilitation program, appointed in the early stages of acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) in patients with arterial hypertension (AH), the analysis of the results at 1 year and 5 years.Material and methods. The study included men (n=62), acute myocardial infarction and undergone PCI in the period from 1 to 8 weeks after surgery. After initial clinical and instrumental examination, patients were randomized in 2 groups:basic “O” group (n=31), where patients were engaged in the educational program “School for patients after acute myocardial infarction” (hereinafter - School) with the involvement of controlled physical training (PT) and uncontrolled (at home) FT (FTdom);control “K” group (n=31), where patients were only trained in the School of Education with a recommendation to participate inuncontrolled FTdom. The patients were examined at the time of inclusion, 1.5, 4, 6 and 12 months. After 5 years, a telephone survey of patients in order to assess their clinical status.The Results. According to the results of exercise test (FN) at 6 and 12 months in the “O” significantly increased physical performance indicators: the duration of FN, its threshold power and total work performed. In the group of “K” after PCI, these figures also significantly increased, but to a lesser extent than in trained patients. By the 12th month in the “About” FN duration greater than that seen in the group “K” by 1.7 times (p<0.05), the threshold power made FN and the total amount of physical work performed were 2-fold higher (p<0.05). Efficiency of the heart rate to double product (DP) was significantly increased only in the background controlled by FT by 5,3% (p<0.05) against the lack of its dynamics in untrained. After FT patients noted positive changes in volume terms echocardiography. Also noted a positive increase in cholesterol (TC) high density lipoprotein to 10.8% (p<0.05), while in group “C” had a growth of low-density lipoprotein cholesterol at 12 months of follow-up 13,8% (p<0,05). Patients of group “O” frequency of angina attacks during the year has not changed, whereas in group “C” significantly increased by 77.7% (p<0.05). Participation of patients with hypertension, acute myocardial infarction and PCI in complex rehabilitation program (Education School + FT) resulted in clinical improvement in 18 (58.1%) patients compared with 5 (16.1%) patients in the “K” (p<0.01). The deterioration of the clinical condition occurred only in 7 (22.6%) patients of the “K” in the absence of the dynamics in patients of group “O” (0 patients; p<0.05).Conclusions. The use of a short course of TF in conjunction with the educational program within the School has improved the clinical condition of patients with hypertension and coronary artery disease after PCI in the long-term follow.

rehabilitation, percutaneous coronary intervention, acute myocardial infarction, coronary heart disease, hypertension