Nurse Practitioner Mackay Memorial Hospital Rehabilitation Department R.O.C. (Taiwan) New Taipei City, New Taipei, Taiwan (Republic of China)
Case Diagnosis: Anterior-wall STEMI (V2–V4) s/p primary PCI, confirmed by chest pain, ST elevation, and elevated CK-MB 204.2 ng/mL/troponin-I 0.73 ng/mL. Post-PCI stable. Risks: ~20 pack-years smoking, impaired fasting glucose 126 mg/dL. Referred to supervised CR 1 week post-PCI; baseline CPET: peak VO₂ 23.92 mL·kg⁻¹·min⁻¹ (59% predicted), peak HR 133 bpm (77% predicted).
Case Description: A 41-year-old man with no prior history presented with anterior STEMI, received urgent primary PCI, and remained hemodynamically stable. ECG showed ST elevation in V2–V4; labs: fasting glucose 126 mg/dL, CK-MB 204.2 ng/mL, troponin-I 0.73 ng/mL. He smoked ~1 pack/day. One week post-PCI he was referred to supervised outpatient cardiac rehabilitation. Baseline CPET demonstrated reduced aerobic capacity and submaximal chronotropic response (peak VO₂ 23.92 mL·kg⁻¹·min⁻¹, 59% predicted; peak heart rate 133 bpm, 77% predicted), informing initiation of a structured hospital-based program.
Discussions: Supervised cardiac rehabilitation begun 1 week after primary PCI for AMI was feasible and yielded CPET-documented gains over 12 weeks: peak VO₂ 23.92→35.41 mL·kg⁻¹·min⁻¹ (59%→88% predicted) and peak HR 133→147 bpm (~77%→~86%). A modest, twice-weekly protocolized treadmill program (~6.8 METs) with CPET-anchored dosing and supervised progression achieved these improvements. Embedding automatic post-PCI referral with baseline CPET enables individualized prescriptions and objective verification. Limitations: single case, treadmill-centric training, short follow-up without clinical endpoints. Overall, findings support early, protocol-driven CR with objective testing after PCI.
Conclusions: Early, protocol-driven cardiac rehabilitation initiated one week after primary PCI for AMI was feasible and safe, yielding substantial, CPET-documented improvements in aerobic capacity (peak VO₂ 23.92→35.41 mL·kg⁻¹·min⁻¹) and chronotropic response (peak HR 133→147 bpm) over 12 weeks. A modest, supervised treadmill program with progressive titration and integrated risk-factor counseling produced clinically meaningful gains. Embedding automatic post-PCI referral with a baseline CPET enables individualized dosing and objective verification of response. Larger studies should compare within-7-day versus later initiation and assess durability and clinical endpoints.
