Introduction

In Poland, about 85-90 thousand people suffer from acute Myocardial Infarction (AMI) every year. Women constitute 48% of patients with AMI. Despite a well-functioning network of interventional cardiology departments and a large percentage of patients treated invasively Percutaneous Coronary Intervention (PCI) (59% vs. Coronary Artery Bypass Graft (CABG) 1.9% vs. thrombolysis 1%), mortality at 1-year follow-up remains high (total, 19.4%; in-hospital mortality, 10.5%; and mortality after discharge, 8.9%). However, women after AMI continue to have a worse prognosis than men [1]. According to the AMI-PL register, only 22% of patients participate in cardiac rehabilitation (CR) in the first 12 months after a MI [2]. Early cardiac rehabilitation is an important component of the therapeutic process after myocardial infarction. Multiple meta analyses have reported that cardiac rehabilitation reduces overall mortality in patients With Coronary Artery Disease (CAD) [3-6]. Considering scientific reports and the results of national registers Polish Cardiac Society, the National Health Foundation and Ministry of Health of Poland have created a program of coordinated care for patients with MI (MC-AMI, in polish KOSzawal) [7]. The program includes treatment of the acute phase of myocardial infarction, early cardiac rehabilitation, ambulatory care in the first year after the MI, qualification and possible implantation of Cardiac Implantable Electronic Devices (CEID).

There is still a lack of data on possible improvement in long-term prognosis among women after AMI who were involved in early cardiac rehabilitation.

The aim of this study is to compare the male and female population participating in the MC-AMI program regarding Major Cardiovascular Events (MACE), defined as a composite of death, recurrent myocardial infarction, and hospitalization for heart failure during a 1-year follow-up period.

Methodology

We present prospective research from a single cardiology care centre, where the MCAMI program was included as a care standard. The study groups included all AMI patients from November 1, 2017 to August 31, 2018 who agreed to participate in MC-AMI. The study compares two groups: female population (group 1, n=167) and male population (group 0, n=362). All patients were at least 18 years old and agreed to participate in the MC-AMI program.

The MC-AMI program consists of four integrated modules. Treatment of acute coronary syndrome according to ESC guidelines (module I), early cardiac rehabilitation in outpatient or stationary conditions (module II), qualification for CEID implantation (module III), and 12 months of observation in a cardiology outpatient clinic (module IV).

The program included those patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) and ST-Elevation Myocardial Infarction (STEMI), who agreed to participate in MC-AMI. Treatment was based on guidelines. Each patient began cardiac rehabilitation within 14 days, which was preceded by a coordinating visit. During the screening visits, basic laboratory parameters (CRP, creatinine, electrolytes and morphology) were monitored.

Patients were qualified for outpatient cardiac rehabilitation or in-hospital cardiac rehabilitation based on peri-infarction and comorbidities. After completion of the CR, the patients were monitored at outpatient clinics for the next 12 months. Control visits were scheduled every 3-4 months. During the visit, each patient was evaluated for the indication for implantable cardioverter-defibrillator (ICD) and Cardiac Resynchronization Therapy (CRT) implantation. In a research we compare the male and female population participating in the MC-AMI program regarding Major Cardiovascular Events (MACE), defined as a composite of death, recurrent myocardial infarction, and hospitalization for heart failure during a 1-year follow-up period.