Abstract 3543: Long-Term Benefits of Cardiac Rehabilitation in Patients With Incomplete Revascularization: 5-Year Follow-up.
There is evidence that cardiac rehabilitation (CR) determines important benefits in patients with coronary artery disease(CAD). However, it is unclear whether CR may improve the outcome of pts with incomplete revascularization (IR) after PTCA/stenting and/or coronary artery bypass surgery (CABG). From 1/1/2002 to 30/11/2004, we prospectively studied 259 patients with CAD who underwent PTCA after a SCA or CABG in 1(10/7%, respectively), 2(20/19%) and 3 major coronary arteries (70/74%). Patients were randomized into 2 homogeneous groups on the basis of the results of cardiopulmonary exercise stress testing(CPET) performed twice one week apart: a group with a positive CPET for inducible ischemia (P, n=129), and a group with a negative CPET (N, n=130). Patients were further randomized into 2 groups. The intervention group(Group CR) received CR combining exercise training (60%peak VO2, 3 times a week for 8 weeks)+ nutrition counseling+ standard medications (65P+65N, 25% women, mean age 56±8 years), while the control group (Group C) had no CR (65P+64N, 25% women, mean age 58±8 years). On entry and at 8 weeks all patients underwent CPET, brachial artery flow-mediated dilation (BA-FMD) and blood chemistry. Group CR-N had more marked improvements in peak VO2 and FMD than CR-P (P<0.001 for both). However, CPET became negative in 22% post PTCA CR-P patients and 28% post CABG CR-P (P<0.001 vs initial). After 8 weeks, group CR was recommended to continue a home program of exercise training with periodic supervision at the hospital’s gym, while group C was not. At 5 years, both peak VO2 and FMD were significantly higher in CR (P<0.01 vs C) with no differences between CR-P and CR-N. Cardiovascular risk profile (CVRP) was significantly improved in CR (P<0.01 vs C). Cardiac events were significantly lower in CR than C : new acute coronary syndrome (P<0.001); new PCI (P<0.0001); new CABG(P<0.001); hospital readmission: (P<0.0001); cardiac death (P<0.05). Multivariate analysis demonstrated that the lower rate of events in CR was not collinear with changes in CVRP. In conclusion, IHD patients with IR take advantage from CR and maintain a higher functional capacity and a better control of CVRP at 5 years. These benefits were associated with a better outcome.