{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:57:53Z","timestamp":1760151473126,"version":"build-2065373602"},"reference-count":33,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T00:00:00Z","timestamp":1648598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Several risk scores have been used to predict risk after an acute coronary syndrome (ACS), but none of these risk scores include functional class. The aim was to assess the predictive value of risk stratification (RS), including functional class, and how cardiac rehabilitation (CR) changed RS. Two hundred and thirty-eight patients with ACS from an ambispective observational registry were stratified as low (L) and no-low (NL) risk and classified according to exercise compliance; low risk and exercise (L-E), low risk and control (no exercise) (L-C), no-low risk and exercise (NL-E), and no-low risk and control (NL-C). The primary endpoint was cardiac rehospitalization. Multivariable analysis was performed to identify variables independently associated with the primary endpoint. The L group included 56.7% of patients. The primary endpoint was higher in the NL group (18.4% vs. 4.4%, p &lt; 0.001). After adjustment for age, sex, diabetes, and exercise in multivariable analysis, HR (95% CI) was 3.83 (1.51\u20139.68) for cardiac rehospitalization. For RS and exercise, the prognosis varied: the L-E group had a cardiac rehospitalization rate of 2.5% compared to 26.1% in the NL-C group (p &lt; 0.001). Completing exercise training was associated with reclassification to low-risk, associated with a better outcome. This easy-to-calculate risk score offers robust prognostic information. No-exercise groups were independently associated with the worst outcomes. Exercise-based CR program changed RS, improving classification and prognosis.<\/jats:p>","DOI":"10.3390\/jcm11071910","type":"journal-article","created":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T21:28:39Z","timestamp":1648675719000},"page":"1910","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prognostic Utility of a New Risk Stratification Protocol for Secondary Prevention in Patients Attending Cardiac Rehabilitation"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1060-4601","authenticated-orcid":false,"given":"Ignacio","family":"Cabrera-Aguilera","sequence":"first","affiliation":[{"name":"Unit of Biophysics and Bioengineering, Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Department of Human Movement Sciences, School of Kinesiology, Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Consolaci\u00f3","family":"Ivern","sequence":"additional","affiliation":[{"name":"Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4960-8634","authenticated-orcid":false,"given":"Neus","family":"Badosa","sequence":"additional","affiliation":[{"name":"Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ester","family":"Marco","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit, Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar\u2014Hospital de l\u2019Esperan\u00e7a), 08003 Barcelona, Spain"},{"name":"Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier","family":"Duran","sequence":"additional","affiliation":[{"name":"Methodological and Biostatistical Advisory Service, IMIM (Institut Hospital del Mar d\u2019Investigacions M\u00e8diques), 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Moj\u00f3n","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miren","family":"Vicente","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Llagostera","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3110-6572","authenticated-orcid":false,"given":"Nuria","family":"Farr\u00e9","sequence":"additional","affiliation":[{"name":"Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6074-914X","authenticated-orcid":false,"given":"Sonia","family":"Ru\u00edz-Bustillo","sequence":"additional","affiliation":[{"name":"Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Pompeu Fabra, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,30]]},"reference":[{"key":"ref_1","first-page":"e9349","article-title":"Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study","volume":"12","author":"Hashim","year":"2020","journal-title":"Cureus"},{"key":"ref_2","first-page":"289","article-title":"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation","volume":"42","author":"Collet","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.cct.2012.01.001","article-title":"TIMI, GRACE and alternative risk scores in Acute Coronary Syndromes: A meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients","volume":"33","author":"Moretti","year":"2012","journal-title":"Contemp. Clin. Trials"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.repc.2015.11.010","article-title":"Valida\u00e7\u00e3o externa do score de risco ProACS para estratifica\u00e7\u00e3o de risco de doentes com s\u00edndrome coron\u00e1ria aguda","volume":"35","author":"Rosa","year":"2016","journal-title":"Rev. Port. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e000960","DOI":"10.1161\/JAHA.114.000960","article-title":"Prognostic value of estimated functional capacity incremental to cardiac biomarkers in stable cardiac patients","volume":"3","author":"Tang","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1161\/01.CIR.57.1.64","article-title":"The role of the exercise test in the evaluation of patients for ischemic heart disease","volume":"57","author":"McNeer","year":"1978","journal-title":"Circulation"},{"doi-asserted-by":"crossref","unstructured":"Winnige, P., Filakova, K., Hnatiak, J., Dosbaba, F., Bocek, O., Pepera, G., Papathanasiou, J., Batalik, L., and Grace, S.L. (2021). Validity and Reliability of the Cardiac Rehabilitation Barriers Scale in the Czech Republic (CRBS-CZE): Determination of Key Barriers in East-Central Europe. Int. J. Environ. Res. Public Health, 18.","key":"ref_7","DOI":"10.3390\/ijerph182413113"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/S0300-8932(00)75211-0","article-title":"Gu\u00edas de pr\u00e1ctica cl\u00ednica de la Sociedad Espa\u00f1ola de Cardiolog\u00eda en prevenci\u00f3n cardiovascular y rehabilitaci\u00f3n card\u00edaca","volume":"53","author":"Velasco","year":"2000","journal-title":"Rev. Espa\u00f1ola Cardiol."},{"unstructured":"(2022, March 24). Procedimiento Rehabilitaci\u00f3n Cardiaca\u2014Sociedad Espa\u00f1ola de Cardiolog\u00eda. Available online: https:\/\/secardiologia.es\/institucional\/reuniones-institucionales\/sec-calidad\/sec-excelente\/procedimientos\/8722-procedimiento-rehabilitacion-cardiaca.","key":"ref_9"},{"unstructured":"American Association of Cardiovascular & Pulmonary Rehabilitation (2016). Guidelines for Cardiac Rehabilitation Programs, American Association of Cardiovascular & Pulmonary Rehabilitation.","key":"ref_10"},{"key":"ref_11","first-page":"255","article-title":"Cardiac risk stratification in cardiac rehabilitation programs: A review of protocols","volume":"29","author":"Bernardo","year":"2014","journal-title":"Rev. Bras. Cir. Cardiovasc."},{"key":"ref_12","first-page":"065","article-title":"Effectiveness of Cardiac Rehabilitation in Increased Left Ventricle Ejection Fraction and Cardiovascular Secondary Prevention","volume":"2","year":"2015","journal-title":"Int. J. Clin. Cardiol."},{"doi-asserted-by":"crossref","unstructured":"Wang, Y., Chien, C.W., Xu, Y., and Tung, T.H. (2021). Effect of Exercise-Based Cardiac Rehabilitation on Left Ventricular Function in Asian Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials. Healthcare, 9.","key":"ref_13","DOI":"10.3390\/healthcare9060774"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/eurheartj\/ehv320","article-title":"2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevationTask Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)","volume":"37","author":"Wang","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_16","first-page":"2109","article-title":"Impact of and Reasons for Not Performing Exercise Training After an Acute Coronary Syndrome in the Setting of an Interdisciplinary Cardiac Rehabilitation Program: Results From a Risk-Op- Acute Coronary Syndrome Ambispective Registry","volume":"12","author":"Ivern","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"126","DOI":"10.3109\/21679169.2016.1145252","article-title":"Fast-track equivalent to traditional cardiac rehabilitation? Pilot study outcome","volume":"18","author":"Bellet","year":"2016","journal-title":"Eur. J. Physioterapy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1093\/aje\/kwk052","article-title":"Relaxing the rule of ten events per variable in logistic and Cox regression","volume":"165","author":"Vittinghoff","year":"2007","journal-title":"Am. J. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.ahj.2004.06.003","article-title":"Impact of age on management and outcome of acute coronary syndrome: Observations from the global registry of acute coronary events (GRACE)","volume":"149","author":"Avezum","year":"2005","journal-title":"Am. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1001\/jama.284.7.835","article-title":"The TIMI risk score for unstable angina\/non-ST elevation MI: A method for prognostication and therapeutic decision making","volume":"284","author":"Antman","year":"2000","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1161\/01.CIR.102.17.2031","article-title":"TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation","volume":"102","author":"Morrow","year":"2000","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1136\/bmj.38985.646481.55","article-title":"Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: Prospective multinational observational study (GRACE)","volume":"333","author":"Fox","year":"2006","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1161\/CIRCULATIONAHA.110.985911","article-title":"Prognostic value of admission glycosylated hemoglobin and glucose in nondiabetic patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention","volume":"124","author":"Timmer","year":"2011","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1016\/j.cjca.2016.02.053","article-title":"Predicting Prognosis in Acute Coronary Syndromes: Makeover Time for TIMI and GRACE?","volume":"32","author":"Waters","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1177\/2047487317724574","article-title":"The impact of drop-out in cardiac rehabilitation on outcome among coronary artery disease patients","volume":"24","author":"Pardaens","year":"2017","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1161\/CIRCULATIONAHA.114.009666","article-title":"Age-specific exercise capacity threshold for mortality risk assessment in male veterans","volume":"130","author":"Kokkinos","year":"2014","journal-title":"Circulation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/0735-1097(93)90832-L","article-title":"Nomogram based on metabolic equivalents and age for assessing aerobic exercise capacity in men","volume":"22","author":"Morris","year":"1993","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1136\/heartjnl-2012-303055","article-title":"Cardiorespiratory fitness changes in patients receiving comprehensive outpatient cardiac rehabilitation in the UK: A multicentre study","volume":"99","author":"Sandercock","year":"2013","journal-title":"Heart"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1002\/ccd.28719","article-title":"Prognostic value of the GRACE discharge score for predicting the mortality of patients with stable coronary artery disease who underwent percutaneous coronary intervention","volume":"95","author":"Zhao","year":"2020","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e000880","DOI":"10.1136\/openhrt-2018-000880","article-title":"Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: A systematic review and meta-analysis of randomised and non-randomised trials","volume":"5","author":"Smart","year":"2018","journal-title":"Open Heart"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Budts","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_32","first-page":"CD001800","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","volume":"2016","author":"McGregor","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"doi-asserted-by":"crossref","unstructured":"Niu, S., Wang, F., Yang, S., Jin, Z., Han, X., Zou, S., Guo, D., and Guo, C. (2020). Predictive value of cardiopulmonary fitness parameters in the prognosis of patients with acute coronary syndrome after percutaneous coronary intervention. J. Int. Med. Res., 48.","key":"ref_33","DOI":"10.1177\/0300060520949081"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1910\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:46:15Z","timestamp":1760136375000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,30]]},"references-count":33,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["jcm11071910"],"URL":"https:\/\/doi.org\/10.3390\/jcm11071910","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,3,30]]}}}