Cardiac Rehab Reduces Late Lumen Loss, Improves Risk Profile in Patients with Long Lesions

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Comprehensive cardiac rehabilitation after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) in patients with long coronary artery lesions reduces in-stent late luminal loss at 9 months while improving patient risk profile and exercise capacity, according to a study published online March 25, 2014, ahead of print in the American Journal of Cardiology.

Researchers led by Seung-Jung Park, MD, PhD, of Asan Medical Center (Seoul, South Korea), analyzed angiographic and clinical data on 576 patients undergoing PCI with DES for long coronary lesions (de novo lesions with a stenosis diameter ≥ 50% and planned total stent length ≥ 28 mm) from the LONG-DES-IV and LONG-DES-V trials. All patients received Phase I of cardiac rehab in-hospital, and 50% (n = 288) voluntarily participated in an additional Phase II outpatient cardiac rehabilitation program post-release (mean, 10.6 sessions).

At 9 months, follow-up angiography was performed in about three-quarters of the overall patient cohort (77.8% in the Phase II group and 72.9% in the Phase I only group). In-stent late lumen loss was 35% lower amongst those who participated in additional cardiac rehab compared with those who did not (0.19 ± 0.33 mm vs 0.29 ± 0.45 mm; P = 0.02).

Additionally, patients who underwent Phase II rehab saw greater improvements compared with baseline in several cardiovascular risk parameters than did Phase I only patients (table 1).

Table 1. Cardiovascular Risk Parameters: Outpatient vs Inpatient Only Rehab

 

Difference in Improvement

P Value

Current Smokers

-7.59%

0.046

Total Cholesterol, mg/dL

-6.58

0.072

HDL Cholesterol, mg/dL

2.10

0.011

LDL Cholesterol, mg/dL

-1.47

0.629

Triglycerides, mg/dL

-11.71

0.063

hs-CRP, mg/dL

-0.08

0.042

HbA1c

-0.93%

0.001

Moderate/Severe Depressiona

-11.16%

< 0.001

Obesity, BMI > 25

-10.27%

< 0.001

aMeasured using the Beck Depression Inventory.

A propensity-matched analysis of 224 patient pairs maintained these results. Moreover, there were no differences in major clinical events between the 2 groups at 12 months.

With outpatient cardiac rehab, maximal oxygen consumption increased from 22.9 ± 4.3 mL/kg/min to 24.4 ± 5.6 mL/kg/min (P < 0.001).

Rehab Cannot Be Randomized

The benefits of cardiac rehab most likely stem from the physiological benefits of exercise, psychological improvement, and better control of underlying cardiovascular risk factors, according to the authors. That outpatient cardiac rehab reduced late luminal loss more than inpatient rehab alone “supports the hypothesis that patients with substantial improvements in risk factors were able to decrease the rate of progression of coronary atherosclerosis, especially in stented segments,” they write.

Because a rehab program “must be recommended as a mandatory therapeutic approach after PCI, randomization is not feasible,” Dr. Park and colleagues say, adding that this issue may “lead to generalizations in our findings.”

In a telephone interview Ajay Kirtane, MD, SM, of Columbia University Medical Center (New York, NY), agreed. “[Cardiologists] recommend [rehab] to virtually everyone. [Completion, however,] really depends upon whether the patient’s lifestyle will accommodate it. It can be a labor intensive process,” he told TCTMD, adding that the study is still “provocative.”

Dr. Kirtane added another possible limitation, in that “this study is observational, so it is important to note that there may be some characteristics about the patients who didn’t do rehab that predispose to restenosis.”

Study Details

Patients had stable or unstable angina, NSTEMI, or inducible ischemia. Both rehab groups had similar baseline characteristics with the exception of higher rates of previous MI and coronary angioplasty in the Phase I only group.

DES used in both the LONG IV and LONG V trials were:

  • Endeavor Resolute (Medtronic; Minneapolis, MN)Cypher Select Plus (Cordis/Johnson & Johnson; Warren, NJ) Nobori (Terumo; Tokyo, Japan) Promus Element (Boston Scientific; Natick, MA)

 


Source:
Lee J-Y, Yun S-C, Ahn J-M, et al. Impact of cardiac rehabilitation on angiographic outcomes after drug-eluting stents in patients with de novo long coronary artery lesions. Am J Cardiol. 2014;Epub ahead of print.

 

 

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Cardiac Rehab Reduces Late Lumen Loss, Improves Risk Profile in Patients with Long Lesions

Comprehensive cardiac rehabilitation after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) in patients with long coronary artery lesions reduces in-stent late luminal loss at 9 months while improving patient risk profile
Disclosures
  • Drs. Park and Kirtane report no relevant conflicts of interest.

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