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Archives of cardiovascular diseases
Volume 112, n° 8-9
pages 459-468 (août 2019)
Doi : 10.1016/j.acvd.2019.04.002
Received : 13 January 2019 ;  accepted : 2 April 2019
Clinical research

Outcome associated with prescription of cardiac rehabilitation according to predicted risk after acute myocardial infarction: Insights from the FAST-MI registries
Évolution associée à la prescription d’une réadaptation cardiaque selon le risque après un infarctus du myocarde :enseignements tirés des registres FAST-MI

Etienne Puymirat a, b, , Marc Bonaca c, Marie-Christine Iliou d, Victoria Tea a, b, Grégory Ducrocq e, Hervé Douard f, Marc Labrunee g, Philoktimon Plastaras h, Pierre Chevallereau i, Guillaume Taldir j, Vincent Bataille k, l, m, Jean Ferrières k, l, m, François Schiele n, Tabassome Simon o, p, q, Nicolas Danchin a, b
for the

FAST-MI investigators

a Department of Cardiology, hôpital Européen Georges-Pompidou (HEGP), AP-HP, 75015 Paris, France 
b Université Paris-Descartes, 75006 Paris, France 
c TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital; and Harvard Medical School, Boston, MA 02115, USA 
d Department of cardiac Rehabilitation, hôpital Corentin-Celton, AP-HP, 92130 Issy-les-Moulineaux, France 
e Department of cardiology, hôpital Bichat, AP-HP, 75877 Paris, France 
f Department of cardiology, hôpital Haut-Lévèque, 33600 Pessac, France 
g Department of Cardiac Rehabilitation, Toulouse University Hospital, 31073 Toulouse, France 
h Department of cardiology, hôpital de Colmar, 68000 Colmar, France 
i Department of cardiology, Centre hospitalier de Libourne, 33500 Libourne, France 
j Department of cardiology, Centre hospitalier de Saint-Brieuc, 22000 Saint-Brieuc, France 
k Department of cardiology B, Toulouse university hospital, 31059 Toulouse, France 
l Department of epidemiology, Toulouse university hospital, 31073 Toulouse, France 
m UMR Inserm 1027, 31000 Toulouse, France 
n Department of Cardiology, Jean-Minjoz University Hospital, 25000 Besançon, France 
o Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), hôpital Saint-Antoine, AP-HP, 75012 Paris, France 
p Université Pierre et Marie-Curie (UPMC-Paris 06), 75005 Paris, France 
q Inserm U-698, 75877 Paris, France 

Corresponding author at: Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.Hôpital Européen Georges-Pompidou20, rue LeblancParis75015France

Cardiac rehabilitation is strongly recommended in patients after acute myocardial infarction.


To assess cardiac rehabilitation prescription after acute myocardial infarction according to predicted risk, and its association with 1-year mortality, using the FAST-MI registries.


We used data from three 1-month French nationwide registries, conducted 5 years apart from 2005 to 2015, including 13130 patients with acute myocardial infarction admitted to coronary or intensive care units. Atherothrombotic risk stratification was performed using the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P). Patients were classified into three categories: Group 1 (low risk; no or one risk indicator; score of 0 or 1); Group 2 (intermediate risk; two risk indicators; score of 2); and Group 3 (high risk; at least three risk indicators; score of3).


Among the 12291 patients, cardiac rehabilitation prescription was 43.6% (49.9% in Group 1; 43.0% in Group 2; 35.2% in Group 3). Using Cox multivariable analysis, cardiac rehabilitation prescription was associated with lower mortality at 1 year in the overall population (3.8% vs. 8.2%; hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.61–0.85; P <0.001). Cardiac rehabilitation was associated with improved 1-year mortality, with homogeneous relative risk reductions in low- and intermediate-risk categories (HR 0.70, 95% CI 0.51–0.94) compared with high-risk patients (HR 0.72, 95% CI 0.59–0.88). In absolute terms, however, mortality decrease associated with cardiac rehabilitation was positively correlated with risk level (Group 1, 0.9% vs. 2.4%; Group 2, 3.0% vs. 4.2%; Group 3, 10.5% vs. 17.3%).


Cardiac rehabilitation prescription was inversely correlated with patient risk. A positive association between cardiac rehabilitation and 1-year survival after acute myocardial infarction was present whatever the risk level, but the greatest mortality reduction was observed in high-risk patients.

The full text of this article is available in PDF format.

La réadaptation cardiaque (RC) est fortement recommandée chez les patients après un infarctus du myocarde (IdM).


Évaluer la prescription de la RC au décours d’un IdM selon un score de risque et son association sur la mortalité à un an, en utilisant les registres FAST-MI.


Nous avons utilisé 3 registres d’un mois, conduits tous les 5 ans entre 2005 à 2015, incluant 13130 patients admis dans une unité de soins intensifs en France pour un IDM. Le score de risque athérothrombotique utilisé était le TIMI Risk Score for Secondary Prevention (TRS-2P). Les patients étaient répartis en 3 catégories: Groupe 1 (bas risque; TRS-2P=0/1); Groupe 2 (risque intermédiaire; TRS-2P=2); et, Groupe 3 (haut risque; TRS-2P3).


Sur les 12291 patients survivants, la prescription de la RC était de 43,6 % (Groupe 1, 49,9 %; Groupe 2, 43,0 %; Groupe 3, 35,2 %). En analyse multivariée, la prescription de la RC était associée à une baisse de la mortalité à un an dans la population globale (3,8 % vs 8,2 %; HR 0,72; IC95 % 0,61–0,85; p <0,001), avec des réductions de risques relatifs homogènes dans les catégories de risque faible et intermédiaire (HR 0,70, IC95 % 0,51–0,94) comparées aux patients à haut risque (HR 0,72, IC95 % 0,59–0,88). En revanche, en valeur absolue, la baisse de la mortalité associée à la RC était corrélée au niveau de risque (Groupe 1, 0,9 % vs 2,4 %; Groupe 2, 3,0 % vs 4,2 %; Groupe 3, 10,5 % vs 17,3 %).


La prescription de la RC était inversement corrélée au niveau de risque des patients. La baisse de la mortalité à 1 an a été observée quel que soit le niveau de risque des patients, avec toutefois une réduction plus marquée en valeur absolue chez les patients à haut-risque.

The full text of this article is available in PDF format.

Keywords : Atherothrombotic risk stratification, Acute myocardial infarction, Cardiac rehabilitation, Score

Mots clés : Stratification risque athérothrombotique, Infarctus du myocarde, Réadaptation cardiaque, Score


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