Background Short and medium-term benefits of cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) have been well studied. However, studies on long-term benefits of such programs after percutaneous coronary intervention (PCI) are scarce. Purpose The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) on very long-term mortality and morbidity after PCI. Methods We conducted a retrospective cohort study of 701 patients who underwent PCI at our hospital between 2004 and 2011. Patients were classified into two cohorts based on whether or not they participated in a CR program phase II. A follow-up was performed in May 2020. We collected the events occurring during a median follow-up of 11 years. Results 701 patients were included in our study: 291 (41.5%) participated in the CR program, whereas 410 (58.4%) refused to do it. AMI was the most frequent indication for PCI (51.9%), followed by unstable angina (42.8%). The characteristics of the cohort based on participation in the CR program are shown in the table below. Patients who participated in the CR program were younger and mostly male. However, those who refused to do it had a higher cardiovascular risk due to a higher percentage of multivessel disease, diabetes mellitus, kidney failure and history of cerebrovascular accident. Using multivariate logistic regression, CR participation was found to be associated with significantly reduced all-cause mortality (19.5 vs 48.4%; OR 0.455; IC95% 0.295–0.701; p<0.001) and cardiac mortality (4.5% vs 18.0%; OR 0.361; IC95% 0.181–0.721; p 0.004). CR is also associated with a substantial decrease in heart failure hospitalization (10.0% vs 24.8%; OR 0.557; IC95% 0.331–0.937; p 0.027) and incidence of stroke (5.5% vs 10.6%; OR 0.491; IC95% 0.271–0.890; p<0.017) during the follow-up. No significant differences were observed in re-AMI (20.6% vs 24.1%, p=NS). Conclusion CR participation after PCI is associated with lower all-cause mortality, cardiac mortality, heart failure hospitalization rates and morbidity during long-term follow-up. FUNDunding Acknowledgement Type of funding sources: None.

Introduction After percutaneous coronary intervention (PCI), patients with diabetes have a worse prognosis than non-diabetics and are at increased risk of recurrent cardiovascular events, hospitalization and higher mortality. Purpose The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) in this high-risk group of patients. Methods We performed a retrospective cohort study of 318 consecutive patients with type 2 diabetes mellitus (DM2) who underwent PCI in our hospital between 2004 and 2011. We classified the patients in two cohorts according to their participation (n=154) or not (n=164) in a CR programme. We collected the events ocurring during a median follow-up of 9 years. Results Using multivariate logistic regression, we found that CR participation was associated with significantly reduced all-cause mortality (53% vs 23%, OR 2.10; IC 95%; 1.16–3.82; p 0.014) and cardiac mortality (3.9% vs 23.8%, OR 8.69; IC95% 2.80–26.99; p<0.0005). CR aslo associated with a singnificant decrease in a heart failure hospitalization (26.6% vs 10.6%, OR 2.4; IC 95% 1.06–5.52; p<0.035). No significant differences were observed in non fatal myocardial infarction, stent restenosis and non fatal stroke. Basal characteristics Rehabilitation (n=153) No Rehabilitation (n=164) P vaule Male sex 138 (86.4%) 100 (61.0%) <0.0005 Age (years) 59 (38–74) 65 (47–74) <0.0005 Hypertension 113 (73.9%) 111 (67.7%) NS Hypercholesterolemia 112 (73.7%) 115 (70.1%) NS HbA1c ≥7% 88 (66.2%) 73 (64.6%) NS Prior myocardial infarction 24 (15.6%) 32 (19.5%) NS Chronic kidney disease 6 (3.9%) 19 (11.6%) 0.012 FEVI <50% 30 (20%) 39 (25%) NS Three vessel disease 53 (34.4%) 58 (35.4%) NS Incomplete revascularization 80 (51.9%) 81 (49.4%) NS Drug-eluting stent 110 (78.6%) 127 (80.4%) NS Stent length 22.4±11.9 24.6±14.8 NS Stent diameter 2.7±0.3 2.8±0.4 NS Conclusion CR participation after PCI is associated with lower all-cause mortality, cardiac mortality and heart failure hospitalization rates in patients with DM2 during long-term follow-up.

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Introduction Conservative treatment unprotected left main coronary (uLMCA) disease has a high mortality rate (50% at 3 years). Since octogenarian patients are often dismissed for surgical treatment, they tend to adopt a more conservative attitude in this population. Purpose We report medium and long-term outcomes of percutaneous coronary intervention (PCI) for uLCMA stenosis in elderly patients. Methods Retrospective cohort study of consecutive patients ≥80 years with uLMCA stenosis, treated with PCI at a single center between June 2005 and February 2017. Results A total of 100 patients were included in the study. 58% were male, with a mean age of 83.8±3 years. There were 86% hypertensive, 63% diabetic and 68% dyslipidemic. 14% of the patients had an LVEF ≤35%. Unstable angina (45%) and acute coronary syndromes withouth ST-segment elevation (44%) were the most common presentation. In 9% of the cases, cardiogenic shock was the initial presentation form. The distal left main coronary was the most frequent localitation of the lesion (46%) followed by the ostium (33%). In 63% of the cases, a multivessel coronary disease was detected and in 47% the revascularization was incomplete. The survival rate after a year follow up was 79% and after three years follow up was 65%. However, in most of the cases the cause of death was due to other comorbidities, with cardiac death being 10% per year and 13% at 3 years of follow-up. The rate of non-fatal acute myocardial infarction was 13% per year, increasing to 20% at 3 years of follow-up. There was a 9% stent restenosis implanted at 3 years. The presence of severe left ventricular systolic dysfunction was the main predictor of mortality in long-term follow-up (OR 1.39 [95% CI 1.10–1.752], p<0.001). Incomplete revascularization was not associated with a higher mortality rate. Conclusion PCI is a safety option for revascularization in uLMCA stenosis in elderly patientes with excellent short-term results, as well as acceptable long-term results. Age should not be a handicap to consider uLMCA revascularization in this population.

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