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Maladaptation after successful revascularization in anginal patients without transmural infarction
Insights
Coronary artery bypass grafting (CABG) may lead to deconditioning due to peripheral issues, particularly in elderly patients. Cardiac rehabilitation after discharge can effectively treat this post-surgery deconditioning.
Area of Science:
- Cardiology
- Exercise Physiology
- Rehabilitation Medicine
Background:
- Deconditioning after coronary artery bypass grafting (CABG) impacts patient recovery.
- Understanding the role of peripheral and cardiac function maladaptations is crucial.
- Limited research exists on exercise capacity changes post-CABG versus percutaneous transluminal angioplasty (PTCA) without cardiac rehabilitation.
Purpose of the Study:
- To evaluate the effects of CABG and PTCA on exercise capacity in anginal patients without myocardial infarction.
- To investigate the potential causes of deconditioning following these procedures.
- To assess the impact on elderly patients specifically.
Main Methods:
- Symptom-limited treadmill exercise tests were conducted on 46 patients pre- and post-CABG and 28 patients pre- and post-PTCA.
- Patients did not participate in cardiac rehabilitation programs post-discharge.
- Exercise capacity was measured in METs (Metabolic Equivalents).
Main Results:
- PTCA significantly improved exercise capacity within 4 weeks (6.4 to 10.5 METs), including in elderly patients (6.0 to 10.3 METs).
- CABG showed a modest improvement in exercise capacity (5.9 to 8.5 METs in 6 months, 5.9 to 10.0 METs thereafter).
- Elderly CABG patients exhibited minimal improvement (6.0 to 6.9 METs in 6 months, 6.3 to 8.7 METs thereafter), with 6 of 15 showing no improvement.
Conclusions:
- CABG itself and/or physical restrictions during hospitalization contribute to peripheral maladaptation and deconditioning, especially in the elderly.
- PTCA demonstrates a more robust and rapid improvement in exercise capacity compared to CABG.
- Post-discharge cardiac rehabilitation is recommended to treat deconditioning following CABG.
Abstract:
In order to elucidate how peripheral or cardiac function maladaptations play a role in deconditioning after coronary bypass surgery, we have evaluated effects of successful coronary artery bypass grafting (CABG) and percutaneous transluminal angioplasty (PTCA) on exercise capacity in anginal patients without myocardial infarction. Symptom-limited treadmill exercise tests were performed in 46 patients before and after CABG and in 28 patients before and after PTCA. None of the patients carried out a cardiac rehabilitation program after their discharge. PTCA patients showed significant improvement of exercise capacity, from 6.4 +/- 1.6 to 10.5 +/- 2.5 METs in 4 weeks after PTCA, and even elderly PTCA patients showed improvement from 6.0 +/- 1.1 to 10.3 +/- 2.5 METs. However, the exercise capacity of CABG patients improved only from 5.9 +/- 1.4 to 8.5 +/- 3.1 METs in the first 6 months after CABG, and from 5.9 +/- 1.7 to 10.0 +/- 3.6 METs thereafter. The 15 elderly CABG patients showed only slight increase of physical activity, from 6.0 +/- 1.7 to 6.9 +/- 1.9 METs in the first 6 months after CABG and from 6.3 +/- 1.9 to 8.7 +/- 2.9 METs thereafter. Furthermore, 6 of 15 elderly CABG patients showed no improved exercise capacity after CABG. There was no correlation between the duration of anginal symptoms before CABG and exercise capacity before or after CABG. These findings suggest that CABG itself and/or physical restriction during admission produces peripheral function maladaptation and may be the main contributors to deconditioning after CABG, especially in elderly patients. This deconditioning can be treated by a rehabilitation program after the discharge.