Post-PCI Cardiac Rehab Nearly Halves Long-term Mortality

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Cardiac rehabilitation substantially improves long-term survival following percutaneous coronary intervention (PCI), according to research published online May 16, 2011, ahead of print in Circulation.

Researchers led by Randal J. Thomas, MD, of the Mayo Clinic (Rochester, MN), retrospectively analyzed data from a registry of 2,395 consecutive patients who underwent PCI in Olmstead County, Minnesota, between 1994 and 2008. The investigators looked for differences in all-cause mortality, cardiac mortality, MI, and repeat revascularization (PCI or CABG) between patients who did or did not attend cardiac rehabilitation.

Overall, 40% of the patients participated in at least one rehab session. During a median follow-up of 6.3 years, 503 patients died, 199 from cardiac causes, while 394 experienced an MI and 755 underwent repeat revascularization.

The investigators used 3 statistical techniques to compare outcomes between the 2 groups: propensity score-matched analysis (n = 1,438), propensity score stratification (n = 2,351), and regression adjustment with propensity score in a 3-month landmark analysis (n = 2,009).

There was a clear all-cause mortality advantage among patients who underwent cardiac rehab using all 3 statistical techniques (HRs ranging from 0.53 to 0.55; P < 0.001). On the other hand, cardiac mortality favored rehab only by propensity score stratification analysis (HR 0.61; 95% CI 0.41-0.91). No differences were seen between the groups with respect to repeat revascularization or MI for any of the analyses (table 1).

Table 1. Unadjusted 5-Year Outcomes


Cardiac Rehabilitation
(n = 964)

No Cardiac Rehabilitation
(n = 1,431)

All-Cause Mortality



Recurrent MI



Repeat Revascularization



The impact of cardiac rehabilitation on outcomes did not differ between men and women, older and younger patients, or those undergoing elective or nonelective PCI.

‘Important Evidence’

“This is an important study,” Carl J. Lavie, MD, of the Ochsner Medical Center (New Orleans, LA), told TCTMD in an e-mail correspondence. “Prior studies have mostly emphasized the benefits after MI (some of those patients having been treated with PCI), and there is also some evidence for benefit after CABG, but only relatively small studies have assessed the benefit after PCI. Therefore, this retrospective analysis certainly suggests very marked benefits following PCI.

“Some purists could make the argument that these data were not randomized, and there could be some selection bias in those who were actually referred to and decided to attend cardiac rehab, which could make them different from those who did not attend,” he acknowledged. “Nevertheless, the baseline characteristics of the population appeared almost identical among those who attended [rehab] and those who did not. Therefore, I believe that almost everyone would agree that this is very important evidence favoring cardiac rehab after PCI.”

Barriers to Rehab

Participation remains a major obstacle. Some studies report rehab attendance of less than 15% following MI, said Dr. Lavie. And “one would expect the PCI attendance to be considerably lower. . . . The elderly, women, rural [dwellers], [those of] lower socioeconomic [status], and less educated patients as well as non-English-speaking patients are all less likely to attend,” he observed.

Also addressing the question of poor participation, Dr. Thomas, in a telephone interview with TCTMD, said the main reasons are that “many [PCI] patients and probably many physicians are not fully aware of the benefits of cardiac rehabilitation. [Also,] many patients and providers may not be aware that cardiac rehabilitation is a covered service following PCI.”

Another barrier is access, he indicated. “Many hospitals do not have a cardiac rehabilitation program, and many cardiologists are not quick to refer to a competitor’s group or hospital that does have [rehab],” Dr. Lavie noted.

How Interventionalists Can Help

“I would recommend that all interventional cardiologists consider putting into their algorithms of treatment that their patients be referred to cardiac rehabilitation after a PCI procedure,” said Dr. Thomas. “Make that a standard, automatic practice.”

Dr. Lavie agreed. “In the setting of PCI, the [physician] with the closest face-to-face contact with the patient is the interventional specialist, so it would help tremendously if this person actually refers the patient and also vigorously encourages the patient to attend,” he said.

“Patients are falling through the cracks because the ball is being dropped between specialists and primary care providers on occasions,” Dr, Thomas added. “So, I would encourage cardiologists to be in close communication with [their patients’] primary providers.”

Dr. Thomas pointed out that some newer models for delivering cardiac rehab are overcoming the access hurdle by providing Internet and telephone-based programs in which patients perform rehab at home under the guidance of a case manager.

Goel K, Lennon RJ, Tilbury, RT, et al. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation. 2011;Epub ahead of print.



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Post-PCI Cardiac Rehab Nearly Halves Long-term Mortality

Cardiac rehabilitation substantially improves long term survival following percutaneous coronary intervention (PCI), according to research published online May 16, 2011, ahead of print in Circulation. Researchers led by Randal J. Thomas, MD, of the Mayo Clinic (Rochester, MN), retrospectively analyzed
  • Dr. Thomas is immediate past president of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). He reports receiving a research grant from the Marriott Family Program in Individualized Medicine and a Community Health Award for Health Promotion Project from Blue Cross-Blue Shield of Minnesota and Stratis Health.
  • Dr. Lavie reports no relevant conflicts of interest.