Exercise-based early cardiac rehabilitation after percutaneous coronary intervention for acute myocardial infarction : A randomized pilot trial.

OBJECTIVE: To evaluate the effects of exercise-based early cardiac rehabilitation (EB-ECR) initiated within 24 h after acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) on cardiac function and functional capacity at 12 weeks. DESIGN: Single-center, parallel-group randomized pilot trial. SETTING: a tertiary hospital with dedicated cardiac rehabilitation services. PARTICIPANTS: clinically stable AMI patients within 24 h of successful PCI. INTERVENTIONS: participants were randomized 1:1 to EB-ECR, consisting of an individualized, phased rehabilitation program initiated in-hospital and continued postdischarge, or usual care without structured cardiac rehabilitation (NO-CR). MAIN OUTCOME MEASURES: Primary endpoints included left ventricular ejection fraction (LVEF), peak oxygen uptake (VO2 peak), 6‑minute walk distance (6 MWT) and B‑type natriuretic peptide (BNP) at 12 weeks. RESULTS: In this study 24 participants were randomized (EB-ECR n = 12; NO-CR n = 12). Compared to NO-CR, baseline-adjusted analyses favored EB-ECR: LVEF was higher by 2.8% (95% confidence interval, CI 0.9-4.8%; p = 0.007), VO2 peak by 2.7 mL·kg-1·min-1 (95% CI 1.5-4.0 mL·kg-1·min-1; p < 0.001), 6 MWT by 24.0 m (95% CI 5.6-42.3m; p = 0.013) and BNP was lower by 18.3% (geometric mean ratio [GMR] 0.82; 95% CI -25.7% to -10.1%; p < 0.001). No serious adverse events occurred; one MACE event occurred in the EB-ECR group and none in the NO-CR group. CONCLUSION: Initiation of EB-ECR within 24 h post-PCI was associated with higher LVEF, greater exercise capacity, and lower BNP at 12 weeks without an observed excess of short-term major adverse cardiovascular events. These findings support the feasibility and potential efficacy of early structured rehabilitation after AMI and PCI.