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



Buckley, Benjamin JR ORCID: 0000-0002-1479-8872, de Koning, Iris A, Harrison, Stephanie L ORCID: 0000-0002-8846-0946, Fazio-Eynullayeva, Elnara, Underhill, Paula, Kemps, Hareld MC, Lip, Gregory YH ORCID: 0000-0002-7566-1626 and Thijssen, Dick HJ
(2022) Exercise-based cardiac rehabilitation vs. percutaneous coronary intervention for chronic coronary syndrome: impact on morbidity and mortality. EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, 29 (7). pp. 1074-1080.

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Abstract

<h4>Aims</h4>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.<h4>Methods and results</h4>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.<h4>Conclusions</h4>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.

Item Type: Article
Uncontrolled Keywords: Chronic coronary syndrome, Angina, Cardiac rehabilitation, Exercise, Percutaneous coronary intervention, Secondary prevention
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 01 Nov 2021 08:53
Last Modified: 18 Jan 2023 21:25
DOI: 10.1093/eurjpc/zwab191
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3142061