Skip to main content

Table 2 Table of characteristics

From: Benefits of cardiac rehabilitation following acute coronary syndrome for patients with and without diabetes: a systematic review and meta-analysis

First author (year) country Inclusion and description of intervention
(a) Enrolled patients in total study population (n)
(b) Inclusion period
(c) Index event and revascularisation procedure
(d) Providing sector
(e) Duration and frequency of CR
(f) Components of CR
(g) Diabetes specific CR components
(h)BACPR score
ACS patients with diabetes
(a) % of overall enrolled patients
(b) Age (years, mean ± SD)
(c) sex (% female)
Baseline exercise capacity
(e) Completion or adherence to CR
(f) Proportion of type 1 and type 2 diabetes
(g) Duration of diabetes (years)
ACS patients without diabetes
(a) % of overall enrolled patients
(b) Age (years, mean ± SD)
(c) Gender (% female)
(d) Baseline exercise capacity
(e) Completion or adherence of CR
Results
(a) Time point of follow-up
(b) Results reported on exercise capacity
Remarks
Banzer 28] (2003) USA (a) 952
(b) 1993–2001
(c) MI
(d) Medical centre, outpatient
(e) 10-week program, 30–40 min x three/week. Home-based exercise was recommended
(f) Exercise, nutritional counselling, pharmacologic treatment, smoking cessation
(g) Not specified
(h) 5
(a) 26.2%
(b) 62 ± 10
(c) 46%
(d) 5.7 ± 2.3 METs
(e) 38% attended > 70% of scheduled sessions
(f) not reported
(g) not reported
(a) 73.7%
(b) 61 ± 11
(c) 36%
(d) 7.0 ± 2.6 METs
(e) 48% attended > 70% of scheduled sessions
(a) Exercise capacity at 10-week follow-up
(b) ACS patients with diabetes
7.2 METs (26% change)
ACS patients without diabetes
8.9 METs (27% change)
 
Vergès [34] (2003) France (a) 95
(b) not reported
(c) MI, unstable angina
(d) Outpatient
(e) Eight-week program. 70 min, x three /week
(f) Exercise, educational sessions (coronary risk factors, smoking, dietary counselling) provided individually and as group discussions
(g) not reported
(h) 4
(a) 62.1%
(b) 57.4 ± 8.8
(c) 13.6%
(d) 20.2 ± 5.8 Peak VO2 (ml/kg per min)
(e) All patients adhered to at least 92% of all sessions
(f) Type 2 DM only
(g) 5 years (min–max: 0.2–11.7)
(a) 37.9%
(b) 56.7 ± 11.3
(c) 8.3%
(d) 22.4 ± 6.3 Peak VO2 (ml/kg per min)
(e) All patients adhered to at least 92% of all sessions
(a) Exercise capacity at 8-week follow-up
(b)
ACS patients with diabetes
22.6 ± 6.7 Peak VO2 (ml/kg per min) (13 ± 24% change)
ACS patients without diabetes
28.8 ± 8.6 Peak VO2 (ml/kg per min) (30 ± 25% change)
Peak VO2 converted into METs
Hindman [33](2005) USA (a) 1505
(b) September 1999 – April 2004
(c) CABG, CAD, MI, and PCI
(d) Free-standing community hospital-based
(e) 12-week program. 40–50 min x three /week
(f) Structured and supervised exercise, individual counselling and group classes on nutrition, heart health, risk factors, stress management, and lifestyle modification
(g) Triaging of patients to individual nutrition counselling based e.g. diabetes. Using 24-h food log and guidelines for carbohydrate intake for optimal glucose control
(h) 5
(a) 19.4%
(b) 63.2 ± 10.7
(c) 27%
(e)
Overall 5.7 ± 2.3 METs
Males: METs 6.2 ± 2.2
Females: METs 4.5 ± 2.0
(f) Patients completing a minimum of 7 weeks of a 12-weeks CR program included
(g) Not reported
(a) 80.6%
(b) n = 62.1 ± 11.4
(c) 26%
(d) METs 7.1 ± 2.6
Men: METs 7.6 ± 2.6
Women: METs 5.6 ± 2.0
(e) Patients completing a minimum of 7 weeks of a 12-weeks CR program included
(a) Exercise capacity at 12-week follow-up
(b) ACS patients with diabetes
Overall: 7.3 ± 2.4 METs (26.3% change)
ACS patients without diabetes
Overall: 8.9 ± 2.7 METs (25.5% change)
 
Pischke [32] (2006) (USA) (a) 434
(b) Not reported
(c) CAD and CABG/PTCA
(d) Hospital based, outpatient
(e) 12-h initial seminar
 + Group sessions × 3/week for. The next 12 weeks: Exercise and lecturers 60 min x two/week
Group meeting for the next 40 weeks
(f) Aerobic exercise, lectures and demonstrations (e.g., cooking,
instructions in stress management)
(g) Not reported
(h) 5
(a) 21.0%
(b) Male: 59 ± 10
Female: 58 ± 11
(c) 40.0%
(d) METS (ml O2(m/kg)
Male: 8.8 ± 2.8
Female: 6.9 ± 2.1
(e) Attended an average
of 91% of the group support (first three months)
At 1 year, 76% attended group sessions
(f) 9.8% with type 1 diabetes
(g) Not reported
(a) 79%
(b) Male: 58 ± 11,
Female: 60 ± 10
(c) 16.6%
(d) METS (ml O2(m/kg)
Male: 10.4 ± 2.9
Female: 8.3 ± 2.8
(e) Attended an average of
92% of the group support meetings (first three months)
At 1 year, 78% attended group sessions
(a) Exercise capacity at 12-week; 12-month follow-up
(b)
12-week follow-up:
Male ACS patients with diabetes
10.8 ± 2.7 METs
Male ACS patients without diabetes
11.9 ± 2.6 METs
Female ACS patients with diabetes
8.4 ± 2.6 METs
Female ACS patients without diabetes
9.0 ± 2.9 METs
12-month follow-up
Male ACS patients with diabetes
10.8 2.4 METs
Male ACS patients without diabetes
(continued)
12.5 ± 2.8 METs
Female ACS patients with diabetes
8.5 ± 2.8 METs
Female ACS patients without diabetes
10.0 ± 3.0 METs
Results provided stratified by gender and therefore treated separately in meta-analysis
Svacinová [31] (2008) Czech Republic (a) 77
(b) not reported
(c) MI, unstable angina, PCI
(d) Outpatient
(e) 12-week programme, 50 min × 3/week
(f) Aerob training, resistance training
(g) Not reported
(h) 2
(a) 41.6%
(b) 64.3 ± 6.2*
(c) 21.9%
(d) 17.0 ± 4.6 VO2peakkg(ml/kg)
(e) All analysed patients completed the program
(f) Type 2 only
(g) Not reported
(a) 58.4%
(b) 60.9 ± 8.2
(c) 33.3%
(d) 19.1 ± 4.9: VO2peakkg(ml/kg)
(e) All analysed patients completed the program
(a) Exercise capacity at 12-week follow-up
(b) ACS patients with diabetes
19.3 ± 6.0 VO2peakkg(ml/kg)
ACS patients without diabetes
21.1 ± 5.3 VO2peakkg(ml/kg)
Converted into METs
Mourot [35] (2010) France (a) 1027
(b) not reported
(c) CHD: MI event, PTCA or CABG
(d) Rehabilitation centre
(e) 6-week program, × 5 times/week (total of 13 h per week)
(f) Exercise. Education regarding CHD, risk factors, physical practise
(g) DM patients also received education regarding use of devices for self-monitoring glycaemia, injections, and adjusting insulin doses
(h) 4
(a) 40.2%
(b)56.9 ± 7.9
(c) 18.6%
(d) 14 ± 4.3 mLxkg−1xmin−1
(e) All analysed patients completed CR
(f) Type 2 DM only
(g) Not reported
(a) 60.0%
(b) 56.8 ± 10.3
(c) 15.3%
(d) 16.6 ± 5.4 mLxkg−1xmin−1
(e) All analysed patients completed CR
(a) Exercise capacity at six-week follow-up
(b) ACS patients with diabetes
*17.7 ± 5.2 VO2peakkg(ml/kg)
ACS patients without diabetes
*22.0 ± 6.4 VO2peakkg(ml/kg)
Results on METs were originally provided stratified on interventional procedure (CAGB/PTCA). *Unified data were kindly provided by corresponding author
Karjalainen [36]2012 Finland (a) 83
(b) not reported
(c) CAD
(d) Home based, exercise prescription. Daily diary and follow-up at specialists of sports medicine
(e) 12-week programme: 60 min × 4/week. Followed by prescription of × 5/week for 12 weeks for an unknown number of weeks
(f) Homebased heart rate controlled exercise, daily diary, contacted by specialist of sports medicine at 1 and 3 months
(g) Not reported
(h) 2
(a) 47%
(b) 62 ± 5
(c) 18%
(d) 6.5 ± 1.6 METSMAX
(e) Training realization did not differ between the patients with DM and No DM group
(f) Type 2 DM only
(g) Not reported
(a) 53%
(b) 62 ± 5
(c) 27%
(d) 8.1 ± 2.0
(e) Training realization did not differ between the patients with DM and No DM group
(a) Exercise capacity at six-months follow-up
(b)
ACS patients with diabetes
6.9 ± 1.7 METs; 23.2 ± 6.6 VO2 peak
ACS patients without diabetes
8.4 ± 1.9 METs; 28.1 ± 6.8 VO2 peak
VO2peak converted into METs
Nishitani [37] (2013) Japan (a) 78
(b) July 2002- February 2005
(c) CABG
(d) Hospital based, outpatient
(e) 6-months programme, 60 min × 1–2 sessions/week. Patients were encouraged to home-based aerobic exercise
(f) Exercise, all participants were instructed to follow diet according to American Heart Association. Educational program regarding CAD and its risk factors was provided by nurses, physicians and dietitians
(g) Not described
(h) 3
(a) 47%
(b) 63.3 ± 10
(d) 22%
(e)
Peak VO2 (ml kg −1 min−1): 13.7 ± 4.0
(f) Mean exercise sessions: 16 ± 14
(g) Type 2 only
(h) Not reported
(a) 53%
(b) xx
(c) 64.1 ± 9
(d) 5%
(e)
Peak VO2 (ml kg −1 min−1): 16.0 ± 4.7
(f) Mean exercise sessions: 18 ± 14
(a) Exercise capacity at six-month follow-up
(b)
ACS patients with diabetes
19.4 ± 3.8 VO2 peak
ACS patients without diabetes
22.9 ± 5.4 VO2 peak
VO2 peak converted into METs
Toste [38] (2014) Portugal (a) 682
(b) January 2009-June 2013
(c) IHD
(d) Hospital based
(e) 8–12-week program. 60–90 min × 2 /week
(f) Exercise, health education: CAD, nutrition, stress and exercise. Individual counselling
(g) Not reported
(h) 4
(a) 37.0%
(b) 61.6 ± 9.1
(c) 24.5%
(d) 7.9 ± 2.1 METs
(e) Not reported
(f) Type 2 only
(g) Not reported
(a) 62.9%
(b) 58.6 ± 11.0
(c) 21.2%
(d) 9.1 ± 2.4 METs
(e) Not reported
(a) Exercise capacity at 8 to 12-week follow-up
(b)
ACS patients with diabetes
Mean change in METs: 1.3 ± 1.2
ACS patients without diabetes
Mean change in METs: 1.5 ± 1.2
 
Kenttä [39] (2014) Finland (a) 65
(b) Initiated in 2007
(c) CAD
(d) Hospital based
(e) First three months:
60 min of homebased training, 4 heart rate-controlled exercise sessions per week
Progressively increasing so that the last 6 months = 6 exercise sessions per week
(f) Exercise, homebased
(g) not reported
(h) 2
(a) 46.2%
(b) 61.7, standard error of mean (SEM) 1.0
(c) not reported
(d) 5.3 (SEM: 0.3) METs
(e) not reported
(f) not reported
(g) not reported
(a) 53.8%
(b) 61.3, SEM: 0.9
(c)not reported
(d) 6.8 (SEM: 0.3) METs
(e) not reported
(a) Exercise capacity at two-year follow-up
(b)
ACS patients with diabetes
5.7 (SEM 0.3)
ACS patients without diabetes
7.3 (SEM 0.3) METs
 
Armstrong [40] (2014) Canada (a) 8582
(b) 1996–2010
(c) CAD, PCI, CABG
(d) A centralised CR centre, outpatient
(e) 12-week program, 60 min × 2/week. Home-based exercise was recommended
(f) Exercise: aerobic training, stretching and/or resistance training. Offered sessions of nutrition and stress management, referral to dietician or social worker if needed
(g) Not reported
(h) 5
(a) 22%
(b) 60.1 (no SD)*
(c) 28.3%
(d) Men: 7.4 METs
Women:6.6 METs
(e) Completion of CR (completers of baseline test and 12- week test): 1230 (79.6%)
(f) Not reported
(g) Not reported
(a) 78%
(b) 58.9 (no SD)
(c) 26.5%
(d) Men: 8.4 METs
Women: 7.1 METs
(e) Completion of CR (completers of baseline test and 12- week test) 5973 (84.9%)
(a) Exercise capacity at 12 weeks; 12-month
(b) 12-week follow-up
Male ACS patients with diabetes
8.3 METs
Male ACS patients without diabetes
9.4 METs
Female ACS patients with diabetes
7.3 METs
Female cardiac patients without diabetes
8.0 METs
12-month follow-up
Male ACS patients with diabetes
8.0 METs
Male ACS patients without diabetes
9.3 METs
Female ACS patients with diabetes
7.1 METs
Female ACS patients without diabetes
8.0 METs
Results provided stratified by gender and therefore treated separately in meta-analysis
Missing SD imputed from median observed SD
Boukhris [41] (2015) Italy (a) 122
(b) January 2012- August 2013
(c) CAD, PCI and CABG
(d) Out-patient
(e) 5-week program, 70 min × 4/ week
(f) Exercise, psychological and dietary counseling. Patients were encouraged for 1–3 homebased exercise/week
(g) Not reported
(h) 3
(a) 48%
(b) 59.4 ± 8.7
(c) 11.9%
(d) 7.3 ± 2.8 METs
(e) Not reported
(f) Type 2 diabetes only
(g) 4.3 ± 2.6 years
(a) 52%
(b) 61.6 ± 10.1
(c) 11.1%
(d) 7.3 ± 3.3 METs
(e) Not reported
(a) Mean change in exercise capacity ± SD at five-week follow-up
(b)
ACS patients with diabetes
 + 2.9 ± 2.1* (39.7% improvement)
ACS patients without diabetes
 + 3.3 ± 2.4*
(45.2% improvement)
 
Kim [42] (2015) Korea (a) 37
(b) February 2012-January 2014
(c) PCI following MI
(d) Hospital-based, outpatient. Continued follow-up at an outpatient clinic every three month
(e) 8-week programme, 60 min at least 4–8 sessions
(f) Exercise training, information concerning MI, pharmacology, risk factors, nutritional counselling, anti-smoking education
(g) Specific recommendations were provided to patients with diabetes
(h) 5
(a) 32%
(b) 57.0 ± 9.0
(c) 17%
(d) 6.5 ± 0.9 METs
22.7 ± 3.0 VO2peak
(e) Not reported
(f) Type 2 only
(g) 50% had newly diagnosed diabetes at the time of MI
Average morbidity period was 5.33 ± 3.64 years among those with known diabetes
(a) 68%
(b) 55.7 ± 8.4
(c) 4%
(d) 7.2 ± 1.1 METs
25.2 ± 3.7 VO2peak
(e) Not reported
(a) Exercise capacity at 8-week; 12-month follow-up
(b) 8-week follow-up
ACS patients with diabetes
7.2 ± 0.8 METs;
25.3 ± 2.7 VO2peak
ACS patients without diabetes
8.2 ± 1.5 METs;
28.6 ± 5.1 VO2peak
12-month follow-up
ACS patients with diabetes
7.2 ± 1.2 METs;
25.2 ± 4.1 VO2peak
ACS patients without diabetes
8.1 ± 1.7 METs;
28.7 ± 5.3 VO2peak
Provided METs used for meta-analysis
Szalewska [43] (2015) Poland (a) 125
(b) January 2010-December 2013
(c) CAD
(d) Outpatient rehabilitation centre and homebased tele rehabilitation
(e) Outpatient phase: 8–10 days
Homebased phase: 11–12 days, 30 min × 5/week
(f) Outpatient phase: exercise, education, relaxation, secondary prevention strategies. Home-based phase: Endurance training, supervised exercise training, daily mobile phone communication
(g) In patients with DM blood glucose levels were initially obtained before and
(continued)
after exercise to provide an assessment of the individual’s response to exercise
(h) 3
(a) 29.6%
(b) 59.1 ± 3.91
(c) 8.1%
(d) 6.81 ± 1.91 METs
(e) Mean number of days of absence in CR 1.22 ± 2.76
(f) Type 2 only
(g) Not reported
(a) n = 88 (70.4%)
(b) 57.86 ± 4.66
(c) 11.4%
(d) 8.31 ± 2.71 METs
(e) Mean number of days of absence in CR 1.61 ± 4.51
(a) Exercise capacity ± SD; mean change ± SD at mean follow-up 22 days
(b) ACS patients with diabetes
8.30 ± 2.04 METs; + 1.49 ± 2.08
ACS patients without diabetes
9.13 ± 2.87 METs; + 0.81 ± 1.91
 
Khadanga [44] (2016) USA (a) 898
(b) Not reported
(c) CAD: MI, CABG, PCI, chronic stable angina, systolic congestive heart failure
(d) Medical center, outpatient
(e) 3–4 months-programme. 45–60 min × 3/week. Encouraged to exercise on non CR days
(f) Exercise, two class room teachings on heart healthy diet. Behavioral weight loss sessions advised for patients being overweight
(g) Not reported
(h) 5
(a) 22.6%
(b) 64.1 ± 10.9*
(c) 32.6%*
(d) METs: 6.6 ± 2.4
Peak VO2 mLO/kg/min: 17.3 ± 5.8*
(e) 67.0% completed the program
(f) Type 2 only
(g) Not reported
(a) 33.7%, (no insulin resistance group formed the comparison group)
(b) 62.5 ± 10.8
(c) 21.5%
(d) METs: 7.9 ± 2.9
Peak VO2 mLO/kg/min: 21.8 ± 6.8
(e) 60.8% completed the program
(a) Exercise capacity ± SD; mean change ± SD at three to four-month follow-up
(b) ACS patients with diabetes
7.5 ± 2.7 METs; 20.2 ± 5.5 Peak Vo2; + 1.3 ± 2.3
ACS patients without diabetes
10.2 ± 3.4 METs; 25.5 ± 7.8 Peak Vo2;
 + 2.2 ± 2.5
*No insulin resistance group formed the comparison group (without diabetes)
VO2 peak converted into METs
Kasperowicz [45] (2019) Poland (a) 100
(b) 2005–2015
(c) MI treated with invasive procedures
(d) Hospital based
(e) 12 week programme, dose not reported
(f) Exercise
(g) Not reported
(h) 2
(a) 40%
(b) 59.3 ± 7.7
(c) 35%
(d) 7.2 ± 2.0
(e) not reported
(f) not reported
(g) not reported
(a) 60%
(b) 57.6 ± 7.8
(c) 40%
(d) 7.2 ± 2.0
(e) not reported
(a) Exercise capacity ± SD; mean change at three-week follow-up
(b) ACS patients with diabetes
7.7 ± 2.2; + 0.5
ACS patients without diabetes
8.4 ± 1.7; + 1.2
 
Laddu (2020) [46] Canada (a) n = 3953 (analysed patients were propensity matched from entire population)
(b) January 1996- March 2016
(c) Cardiac catheterization and/or revascularization
(d) Hospital based
(e) 12-week programme, 60 min × 2 /week
(f) Exercise and individualized education. Support with risk factor management, and access to a multidisciplinary team of healthcare providers
(g) Measurement of blood glucose at exercise sessions for DM patients
(h) 4
(a) 18.7%
(b) 62.6 ± 9.4
(c) 19%
(d) 6.7 ± 1.9 METs
(e) not reported
(f) Type 2 only
(g) not reported
(a) 81.3%
(b) 62.7 ± 10.7
(c) 20%
(d) 7.2 ± 2.1 METs
(e) not reported
(a) Exercise capacity mean change ± SD at 12-week follow-up
(b) ACS patients with diabetes
0.9 ± 0.9 (13.0%)
ACS patients without diabetes
1.0 ± 1.0 (13.2%)
 
Eser (2020) [47] Eight European countries (a) n = 1633
(b) September 2015 to January 2018
(c) Acute and chronic coronary artery disease (CAD) patients and patients after valve intervention (VHD) with an age 65 or above
(d) Rehabilitation centres in eight european centres: Bern, Copenhagen,
Ludwigshafen, Paris, Parma, Nijmegen, Santiago de
Compostela and Zwolle
(e) 3-weeks to 3-months programme, 10–36 sessions depending on centre
(f) Endurance training, Four of the eight centres also added between
15 and 24 sessions of resistance training, dietary counselling in all centres
(continued)
(g) not reported
(h) 3
(a) n, end of CR = 354, n 1 year = 311*
(b) 72.6 ± 5.5
(c) 19.1%
(c) 14.51 (4.01) VO2 peak
VO2 peak was significantly reduced by 1.46 ml/kg/min at baseline (adjusted for index intervention, sex, age, BMI, comorbidity and cardiovascular risk factors)
(d) 94%, (interquartil range
83–100%)
(e) Type 1 and type 2
(f) previous diagnosis with DM, intake of insulin or oral antidiabetics at start of CR,
HbA1c at baseline of ≥ 48 mmol/mol
(g) not reported
(a) n, end of CR = 976, n, 1 year = 891*
(b) 73.0 ± 5.4
(c) 24.3%
(d) 16.86 (4.89) VO2 peak
(e) 100%, (interquartile range 87–100%)
(a) Exercise capacity ± SD at end of CR (T0-T1), and
1-year follow-up (T0-T2)
(b)
*By end of CR:
ACS patients with diabetes (n = 354): 16.47 (4.41),
ACS patients without diabetes (n = 976): 18.87 (5.23)
*12-months follow-up
ACS patients with diabetes (n = 311): 16.79 (4.47) VO2 peak
ACS patients without diabetes (n = 891): 19.68 (5.45) VO2 peak
* Upon request: VHD group has been excluded in data for the meta-analysis kindly provided by first author
From mixed model adjusted VO2 peak improved in both groups, but with a significantly smaller change in patients with DM (from T0-T2) (-0.6 ml/kg/min) (from additional file 1: S1)
Studies excluded for meta-analysis
First author (year) country Inclusion and description of intervention
(a) Enrolled patients in total study population (n)
(b) Inclusion period
Index event and revascularisation procedure
(d) Providing sector
(e) Duration and frequency of CR
(f) Components of CR
(g) Diabetes specific CR components
ACS patients with diabetes
(a) % of overall enrolled patients
(b) Age (years, mean ± SD)
(c) sex (% female)
(d) Baseline exercise capacity
(e) Completion or adherence to CR
(f) Proportion of type 1 and type 2 diabetes
(g) Duration of diabetes (years)
ACS patients without diabetes
(a) % of overall enrolled patients
(b) Age (years, mean ± SD)
(c) Gender (% female)
(d) Baseline exercise capacity
(e) Completion or adherence of CR
Results
Time point of follow-up
Results reported on exercise capacity
Remarks
Wu [] (2012) Taiwan (a) 61
(b) not reported
(c) CABG
(d) Outpatient facility
(e) 12 weeks. Three sessions/week each lasting 30 min
(f) Exercise only
(g) Not reported
(a) 36.0%
(b) not reported
(c) not reported
(d) not reported
(e) not reported
(f) not reported
(g) not reported
(h) not reported
(a) 63.9%
(b) not reported
(c) not reported
(d) not reported
(e) not reported
(a) Exercise capacity at 12-week follow-up
(b)
Results only provided in graph
Results only provided in graph
St. Clair [] (2013)
USA
(a) 1312
(b) 2004–2012
(c) CAD, CABG and or valvular disease
(d) Medical centre, outpatient
(e) 12-week programme, 3 sessions/week
(f) Exercise. Health and nutrition education sessions
(g) Not reported
(a) 28%
(b) xx
(c) 62 ± 10
(d) 32%
(e) 2.4 ± 0.6 METs
(f) Not reported
(g) Not reported
(h) Not reported
(a) 72%
(b) xx
(c) 63 ± 12
(d) 28%
(e) 2.7 ± 0.9 METs
(f) Not reported
(a) Exercise capacity mean change (95% CI) at 12-weeks
(b)
ACS patients with diabetes
 + 1.7 (1.5–1.9) METs
ACS patients without diabetes
 + 2.5 (2.4–2.7) METs
Low baseline METs
  1. ACS Acute coronary syndrome, AMI acute myocardial infarction, MI Myocardial infarction, CAD coronary artery disease, CHD Coronary heart disease, PCI Percutaneous coronary intervention, CABG coronary artery bypass grafting, PTCA coronary angioplasty, DM diabetes mellitus, BACPR British Association for Cardiovascular Prevention and Rehabilitation