Inflammatory and endothelial markers in heart disease: relation to tissue factor TF - effect of early controlled exercises post acute myocardial infarction on IL6, E-selectin, and TF

INTERVENTION: 1. Usually Patients who are admitted to CCU/Medical wards with acute myocardial infarction are approached by cardiac rehabilitation nurses to invite them to our cardiac rehabilitation program. Patients information sheet concerning this study will be given to all patient, and later on (pre‐discharge from hospital) will be visited by the research Doctor for further discussion, if they are happy to participate in this study a written informed consent will be obtained, and basic clinical information will be recorded on a standard Performa: this will include: Demography, height, weight, BMI, medication, risk factors (smoking status, diabetes, hypercholestraemia, family history, hypertension), any relevant past medical history (MI, CVA, TIA¿etc) will be recorded. 2. Patients undertaking this study will have their blood tested prior discharge from hospital (T0) for the research markers. 3. Patient will do their exercise test within day (5‐14) post acute myocardial infarction, and according to their ETT results will divided into 4 groups: Patient who are unable to exercise for any reason will act as a control group. All eligible patients will have Modified Bruce Protocol within 5‐14 days post acute myocardial infarction. Patient who have negative exercise test for inducible myocardial ischaemia at moderate/high work load(>7 METS), will be randomised using the above mentioned method. Into 4 groups: i) Early rehab with high work load exercises. ii) Late rehab with high work load exercises. iii) Early rehab with low work load exercises. vi) Late rehab with low work load exercises. Blood samples will be collected on attendance for ETT, pre (T1) and post (T2) 4. In addition to our assessment of the above‐mentioned marker all groups will be followed for 12 months in term of: ‐ Mortality (cardiovascular death) ‐ Morbidity (MI, unstable angina, unstable coronary syndrome, LV failure, re‐vascularisation). Blood samples will be obtained through this sheath (15 mls) will be spu CONDITION: Cardiovascular: Acute myocardial infarction ; Circulatory System ; Acute myocardial infarction PRIMARY OUTCOME: 1. Level of IL6/CRP at pre discharge, 1st and last attendance to the gym, 3 & 6 month post myocardial infarction; 2. Level of E‐selectin at pre discharge, 1st and last attendance to the gym, 3 & 6 month post myocardial infarction; 3. Level of TF at pre discharge, 1st and last attendance to the gym, 3 & 6 month post myocardial infarction SECONDARY OUTCOME: Not provided at time of registration INCLUSION CRITERIA: 1. History of recent acute myocardial infarction (within the last 2 weeks) 2. Age 18‐80 3. Able to give written consent