SPC365

Myers and MECKI scores in Cardiac Rehabilitation - comprehensive and simple and reliable tools for risk stratification.

Session: SESSÃO DE COMUNICAÇÕES ORAIS 17 - REABILITAÇÃO CARDÍACA: ESTRATIFICAÇÃO DE RISCO, IMPACTO DO EXERCÍCIO E O PAPEL DA EDUCAÇÃO NA MELHORIA DOS RESULTADOS DOS DOENTES
Speaker: João Mendes Cravo

Congress: CPC 2025
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Comunicações Orais
FP Number: ---
Authors: João Mendes Cravo; Catarina Gregório; Marta Ramalhinho; Paula Sousa; Mariana Ferreira; Pedro Alves da Silva; Nelson Cunha; Inês Aguiar-Ricardo; Fausto .J. Pinto; Ana Abreu

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:&nbsp;</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Several cardiovascular risk stratification protocols exist, but few integrate cardiopulmonary exercise testing (CPET) parameters. The role of CPET in assessing patients and stratifying cardiovascular risk is becoming increasingly recognized. Objective scores, such as the Meyers and MECKI scores, which incorporate CPET parameters, are well established in heart failure, but their utility in other populations, including coronary artery disease, is yet to be validated.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:&nbsp;&nbsp;</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To evaluate the MECKI and Meyers scores as risk stratification tools in patients undergoing cardiac rehabilitation (CR).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong>&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Prospective observational single-center study including patients enrolled in a phase II CR program between 2016 and 2024. The MECKI score was calculated using peak VO2, VE/VCO2 slope, hemoglobin levels, sodium levels, MDRD-estimated glomerular filtration rate and left ventricular ejection fraction (LVEF). The Myers score based on CPET parameters (peak VO2, PetCO2, OUES, HR and VE/VCO2) classified patients into low-, intermediate-, or high-risk categories. Both scores were assessed before and after CR. For analysis on clinical outcomes, a composite outcome of all-cause mortality, cardiovascular hospitalizations and urgent visits was defined.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We gathered 550 patients who completed a phase II CR program (80% male, mean age 63,3 &plusmn; 11 years). The mean number of exercise sessions attended was 14. Among the participants, 83% had ischemic heart disease, with 49% presenting multivessel coronary disease and 29% with incomplete revascularization.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The median MECKI score decreased from 2.29 (0,7-4,8) to 0,95 (0,4-1,8) after completing the program. Similarly, the mean Myers score decreased from 6,02&plusmn;0,4 to 4,69&plusmn;0,4 after CR. Regarding risk stratification using the Myers score, the proportion of patients in the low-risk category increased from 51% to 64% post-CR, while the intermediate-risk group decreased from 42% to 32% and the high-risk group from 7% to 4%. These changes reflected statistically significant improvements in MECKI and Meyers scores from baseline evaluations after CR completion (p&lt;0.001), in line with amelioration of patient risk profile.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The mean follow-up duration was 2,97 &plusmn; 1,69 years. During this period, 44 patients were hospitalized and 21 patients died. A statistically significant association was found between high-risk Meyers scores post-CR and adverse outcomes (p&lt;0.001). Additionally, a trend toward higher event rates was observed in patients whose MECKI and Meyers scores did not improve between pre- and post-CR assessments.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The MECKI and Meyers scores were easily applied in our population and improved after CR, effectively identifying high-risk patients with higher rates of adverse outcomes. These scores help stratify post-phase II CR patients, guiding tailored care and intensive follow-up for high-risk individuals.</span></span></span></p>