Exercise-based cardiac rehabilitation vs. percutaneous coronary intervention for chronic coronary syndrome: impact on morbidity and mortality

Abstract

Aims Accumulating evidence questions the clinical value of percutaneous coronary intervention (PCI) for patients with chronic coronary syndrome (CCS). We therefore compare the impact of exercise-based cardiac rehabilitation (CR) vs. PCI in patients with CCS on 18-month mortality and morbidity, and evaluate the effects of combining PCI with exercise-based CR. Methods and results A retrospective cohort study was conducted in March 2021. An online, real-world dataset of CCS patients was acquired, utilizing TriNetX, a global federated health research network. Patients with CCS who received PCI were first compared with patients who were prescribed exercise-based CR. Second, we compared patients who received both CR + PCI vs. CR alone. For both comparisons, patients were propensity-score matched by age, sex, race, comorbidities, medications, and procedures. We ascertained 18-month incidence of all-cause mortality, rehospitalization, and cardiovascular comorbidity [stroke, acute myocardial infarction (AMI), and new-onset heart failure]. The initial cohort consisted of 18 383 CCS patients. Following propensity score matching, exercise-based CR was associated with significantly lower odds of all-cause mortality [0.37 (95% confidence interval (CI): 0.29–0.47)], rehospitalization [0.29 (95% CI: 0.27–0.32)], and cardiovascular morbidities, compared to PCI. Subsequently, patients that received both CR + PCI did not have significantly different odds for all-cause mortality [1.00 (95% CI: 0.63–1.60)], rehospitalization [1.00 (95% CI: 0.82–1.23)], AMI [1.11 (95% CI: 0.68–1.81)], and stroke [0.71 (95% CI: 0.39–1.31)], compared to CR only. Conclusions Compared to PCI, exercise-based CR associated with significantly lower odds of 18-month all-cause mortality, rehospitalization, and cardiovascular morbidity in patients with CCS, whilst combining PCI and exercise-based CR associated with lower incident heart failure only.

Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes

“…A retrospective cohort study that was conducted online on real-world dataset of CCS patients showed a lower risk of all-cause mortality, rehospitalization and cardiovascular morbidity 1.5 years after diagnosis among patients who underwent exercise-based cardiac rehabilitation compared to those who were referred to PCI. Moreover, the benefit of exercise-based cardiac rehabilitation persisted in several regards (all-cause mortality, rehospitalization, acute MI or stroke) with or without the addition of PCI [ 214 ]. A home-based cardiac rehabilitation program with remote monitoring for frail patients with the help of home physiotherapist and a care giver is feasible for patients with logistical problems attending center-based cardiac rehabilitation programs.…”

Temporal Trends in Cardiac Rehabilitation Participation and Its Core Components

“…The lower participation rate among patients with AP is, at least partially, due to the weaker recommendations (IIB) to participate in CR 3. However, aggressive lifestyle modification, including regular moderate to vigorous exercise and a healthy diet, as well as mental health and risk factor management are important in the secondary prevention of AP patients and show promising results 3,28. Accordingly, future studies should investigate the independent and additive benefits of CR in patients with AP.…”

The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 6: Sex- and Gender-Specific Diagnosis and Treatment

“… 191 , 192 , 193 In a recent retrospective cohort study (n = 18,383), exercise-based CR was linked to significantly lower odds of all-cause mortality (0.37; 95% CI, 0.29-0.47) and rehospitalization (0.29; 95% CI, 0.27-0.32) compared with PCI or PCI plus CR. 194 However, results were not stratified by sex.…”