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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Exercise-based cardiac rehabilitation vs. percutaneous coronary intervention for chronic coronary syndrome: impact on
Benjamin J R Buckley1,2, Iris A de Koning3, Stephanie L Harrison1,2
1Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK.
Insights
Exercise-based cardiac rehabilitation (CR) significantly reduces mortality and morbidity in chronic coronary syndrome (CCS) patients compared to percutaneous coronary intervention (PCI). Combining CR with PCI offers no additional mortality or major cardiovascular benefit over CR alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Preventive Cardiology
Background:
- Clinical evidence questions the utility of percutaneous coronary intervention (PCI) for chronic coronary syndrome (CCS).
- Comparative effectiveness of exercise-based cardiac rehabilitation (CR) versus PCI in CCS requires further investigation.
- The role of combined CR and PCI in CCS management remains unclear.
Purpose of the Study:
- To compare the 18-month impact of exercise-based CR versus PCI on mortality and morbidity in CCS patients.
- To evaluate the outcomes of combining PCI with exercise-based CR compared to CR alone in CCS patients.
Main Methods:
- Retrospective cohort study using the TriNetX real-world data network.
- Propensity-score matching of CCS patients who received CR, PCI, or both.
- Ascertainment of 18-month incidence of all-cause mortality, rehospitalization, and cardiovascular comorbidities (stroke, AMI, heart failure).
Main Results:
- Exercise-based CR was associated with significantly lower odds of all-cause mortality, rehospitalization, and cardiovascular morbidities compared to PCI.
- The combination of CR and PCI did not show significantly different odds for all-cause mortality, rehospitalization, or AMI compared to CR alone.
- Patients receiving CR + PCI showed no significant difference in stroke incidence compared to CR alone.
Conclusions:
- Exercise-based CR demonstrates superior outcomes to PCI in reducing 18-month mortality, rehospitalization, and cardiovascular morbidity in CCS patients.
- Combining PCI with CR does not provide additional mortality or major cardiovascular event benefits compared to CR alone.
- The findings support exercise-based CR as a primary strategy for managing CCS patients.
Aims:
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.
Methods And Results:
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.
Conclusions:
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.
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