Impact of cardiac rehabilitation and treatment compliance after ST-segment elevation myocardial infarction (STEMI) in France, the STOP SCA+ study

Abstract

AbstractIntroductionAcute ST elevation myocardial infarction (STEMI) is one frequent and serious presentation of acute coronary syndrome. The STOP SCA+ study aimed to identify factors associated with negative outcomes one year after STEMI, particularly the impact of rehabilitation care and compliance.MethodsPatients>18 years old hospitalized for STEMI management in five interventional cardiac centers in one French region (2.5 million inhabitants), between 2014 and 2018, were included. After a probabilistic matching with the National Health Insurance database (SNDS, 96% matching), compliance for cardiac tri-therapy was studied: aspirin, P2Y12 inhibitor statin. Factors associated with poor outcomes (ischemic complications, death) were analyzed using Cox modelling and those for the compliance by logistic regression.Results3,768 patients were included, with 84% of primary percutaneous coronary intervention. At one year, 3,362 were prescribed a tri-therapy (89.2%) among whom 53% were compliant; 2,478 patients went to cardiac rehabilitation (65.8%). Death occurred in 130 patients and/or ischemic complication in 194 (total poor outcome 8.0%). Compliance was not associated with complications over the year (HR 1.16 [0.86-1.57]), while the absence of cardiac rehabilitation was (2.31 [1.73-3.08]). Additionally, cardiac rehabilitation was associated with compliance (OR 1.55 [1.34-1.79]).DiscussionSTEMI clinical evolution at one year is mainly favorable. Pejorative outcomes were scarce, and appeared to be related to patients’ characteristics, initial STEMI presentation, and no access to rehabilitation. Compliance part in patient health outcome will need further modelling to accurately study its impact. Matching clinical and medico-administrative databases proved to be relevant for assessing outcomes at a large scale.Key learning pointsWhat is already knownAlthough the compliance with a cardiac treatment and cardiac rehabilitation immediately after a myocardial infarction are key factors for improving the prognosis, less is known about compliance maintenance at one year.What this study addsAt one year, few poor outcomes occurred and were not associated with compliance to the cardiac tri-therapy, while they were associated with the absence of cardiac rehabilitation.Matching two complementary clinical and medico-administrative databases proved to be reliable for assessing outcomes on a large scale (4,000 individuals over 5 years).