Significative Residual Coronary Disease: Problem or Indication for a Cardiac Rehabilitation Program?

Abstract

Introduction: Cardiac rehabilitation programs (CRP) are recommended (Class I, level of evidence A) in the entire spectrum of coronary disease , including after percutaneous coronary interventions . However, current evidence is unclear about the impact of CRP in patients with significant residual stenosis after PCI, thereby many cardiac rehabilitation program consider them inegible.

Aim: We aimed to evaluate the influence of residual significant coronary stenosis (in other territories) in response to a multidimensional CRP.

Methods and Materials: Retrospective analysis of 369 patients enrolled in a cardiac rehabilitation programs (phase II) who underwent successful PCI (residual stenosis <10% and final TIMI flow grade 3) after acute coronary syndrome (ACS). Patients were categorized according to the presence of significant anatomic stenosis (≥ 50%) in additional non-revascularized coronary territories (EST+). We collected data on socio-demographic characteristics, cardiovascular (CV) risk profile and ACS characteristics. The functional capacity [metabolic equivalents (MET) and total duration of the exercise stress test (min:sec)], the psychosocial profile (based on hospital anxiety and depression scale ) and quality of life (based on short-form-36 health survey) were assessed at the baseline and end of the CRP. Intragroup comparisons were performed using paired student’s t-test or Wilcoxon test, and the Mcnemar. For intergroup comparisons we used the t-student or Mann-Whitney test, and the Qui-square.

Results: The groups did not differ in age, but there was a higher prevalence of women and lower proportion of active workers in the group EST+. The group EST+ had a worse CV risk profile and worse baseline functional capacity. There were no differences in the ACS characteristics, psychosocial profile and general perception of health status. Both groups showed significant improvement in functional capacity [1.5(1.61) MET versus +2.1(1.5), ρ<0.001], and not significantly different between groups (ρ = 0.91); significant improvement in both physical dimensions [(+3.6 (6.5) vs. +3.1 (6.7), ρ <0.001] and mental dimensions of the SF36, only in the group EST-. As for psychosocial profile, we found a significant reduction in anxiety only in the group EST-.

Conclusion: The benefit of multidimensional PRC seems to be extended to patients with residual coronary disease. However, the heterogeneity of this group, suggests caution in interpreting these results and should be considered when deciding on the referral.