Published online before print March 8, 2004, doi: 10.1161/01.CIR.0000121360.31954.1F
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(Circulation. 2004;109:1371-1378.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Percutaneous Coronary Angioplasty Compared With Exercise Training in Patients With Stable Coronary Artery Disease
A Randomized Trial
From Universität Leipzig, Herzzentrum GmbH, Klinik für Innere Medizin/Kardiologie (R.H., C.W., S.M.-W., S.G., A.L., K.C., S.E., P.S., G.S.) and Klinik und Poliklinik für Nuklearmedizin (R.K., K.K., O.S.), Leipzig, Germany.
Correspondence to Rainer Hambrecht, MD , Professor of Medicine, Klinik für Innere Medizin/Kardiologie, Universität Leipzig – Herzzentrum GmbH, Strümpellstraße 39, 04289 Leipzig, Germany. E-mail hamr{at}medizin.uni-leipzig.de
Received July 8, 2003; de novo received October 13, 2003; revision received December 18, 2003; accepted December 30, 2003.
Background— Regular exercise in patients with stable coronary artery disease has been shown to improve myocardial perfusion and to retard disease progression. We therefore conducted a randomized study to compare the effects of exercise training versus standard percutaneous coronary intervention (PCI) with stenting on clinical symptoms, angina-free exercise capacity, myocardial perfusion, cost-effectiveness, and frequency of a combined clinical end point (death of cardiac cause, stroke, CABG, angioplasty, acute myocardial infarction, and worsening angina with objective evidence resulting in hospitalization).
Methods and Results— A total of 101 male patients aged 
70 years were recruited after routine coronary angiography and randomized to 12 months of exercise training (20 minutes of bicycle ergometry per day) or to PCI. Cost efficiency was calculated as the average expense (in US dollars) needed to improve the Canadian Cardiovascular Society class by 1 class. Exercise training was associated with a higher event-free survival (88% versus 70% in the PCI group, P=0.023) and increased maximal oxygen uptake (+16%, from 22.7±0.7 to 26.2±0.8 mL O2/kg, P<0.001 versus baseline, P<0.001 versus PCI group after 12 months). To gain 1 Canadian Cardiovascular Society class, $6956 was spent in the PCI group versus $3429 in the training group (P<0.001).
Conclusions— Compared with PCI, a 12-month program of regular physical exercise in selected patients with stable coronary artery disease resulted in superior event-free survival and exercise capacity at lower costs, notably owing to reduced rehospitalizations and repeat revascularizations.
Key Words: coronary disease • exercise • angina • angioplasty • cost-benefit analysis
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