Abstract 4127: Regular Exercise Training Compared to PCI in Patients with Stable Coronary Artery Disease: 4-Year Results of the PET Pilot Study
In a randomized trial (PET Pilot trial) it was shown that in selected patients (pts) with stable coronary artery disease (CAD) daily physical exercise training (ET) on top of medical treatment is at least as effective as PCI/stent implantation (S) regarding clinical symptoms, exercise capacity and improvement of myocardial perfusion after 12 months. Furthermore regular physical exercise leads to a better event free survival than PCI after 12 months. In this abstract the 4-year follow-up results of the PET Pilot trial are presented. 101 male pts with stable CAD and coronary lesion amenable for PCI/stent implantation have underwent their 4-year-follow-up (4Y). Pts of S had a PCI/stent implantation of the initially defined coronary stenosis and pts of ET underwent an initial in-hospital bicycle ergometer training for two weeks. After this conditioning period pts exercised two times daily on a bicycle ergometer at home. Both groups were on standard medical therapy. A maximal symptom limited ergospirometry and clinical symptoms as well as cardiovascular events were assessed at begin (B) and every year after randomization. The following events were included in the predefined ischemic end-point: death, non-fatal myocardial infarction, cerebrovascular accident, need for any revascularization procedure due to unstable angina pectoris and hospitalization due to worsening of angina pectoris. After 48 months both groups showed a significant reduction in CCS-Class (1.5±0.6 at B vs. 0.5±0.3 at 4Y in ET, p<0.001 and 1.7±0.5 at B vs. 0.6±0.3 at 4Y in S, p<0.001). Maximal oxygen consumption (VO2max) increased by 16% in ET (22.4±4.3 at B vs. 25.7±5.3 ml/min/kg at 4Y; p<0.005) and by 10% in S (20.8±4.1 at B vs. 22.8±4.2 ml/min/kg at 4Y; p<0.05). During the 48 months follow-up there were 23 cardiovascular events in ET vs. 44 cardiovascular events in S. This resulted in an event free survival of 70% in ET vs. 50% in S. In conclusion, after 4 years both therapy strategies, daily regular exercise training and PCI/stent implantation lead to comparable effects on clinical symptoms and exercise capacity in pts with stable coronary artery disease, whereas incidence of cardiovascular events remains significantly lower in ET.