Work capacity after myocardial revascularization: factors related to work resumption

For patients with coronary artery disease the ability to retain or resume a normal occupation must be one of the goals of myocardial revascularization procedures. Provided myocardial revascularization is sufficiently complete and left ventricular function is not severely impaired, this goal should be achieved in virtually all cases. The rates of return to work after coronary surgery, however, are often lower than what could be expected. Analysis of the factors related to work resumption after coronary surgery shows that non-medical preoperative parameters (age, educational level, type of occupation, and, most of all, length of preoperative unemployment) are major predictors of subsequent re-employment, whereas medical preoperative factors have little or no influence on return to work. In contrast, re-employment following coronary surgery is strongly influenced by the success of the revascularization procedure, with much fewer patients resuming work in case of poor exercise capacity or persisting angina after surgery. Percutaneous transluminal coronary angioplasty is usually given to patients with less extensive coronary artery disease, and rates of return to work higher than after surgery are observed; re-employment after PTCA is also influenced by the initial result of the procedure. Recognition of the factors negatively influencing return to work after myocardial revascularization is important in an attempt to improve work resumption by appropriate medical, psychological and social measures.