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Published on: April 19, 2019
The Association Between a Second Course of Cardiac Rehabilitation and Cardiovascular Outcomes Following Repeat
Wenliang Zhang1, Marta Supervia, Yaoshan Dun
1Xiangya Hospital, Central South University, Changsha, China (Drs Zhang and Dun); Department of Physical Medicine and Rehabilitation, Gregorio Marañon General University Hospital, Gregorio Marañon Health Research Institute, Madrid, Spain (Dr Supervia); Departments of Quantitative Health Sciences (Mr Lennon) and Cardiovascular Medicine (Drs Sandhu, Tilbury, Squires, and Thomas), Mayo Clinic, Rochester, Minnesota; Cardiovascular Department, Peking University People's Hospital, Beijing, China (Dr Ding); Department of Cardiology, Olmsted Medical Center, Rochester, Minnesota (Dr Tabatabaei); Halifax Health, Daytona Beach, Florida (Dr Tabatabaei); and Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois (Dr Vardar).
Insights
A second cardiac rehabilitation (CR) course after repeat percutaneous coronary intervention (PCI) significantly lowers adverse cardiovascular events. This supports repeat CR for patients with recurrent coronary artery disease (CAD).
Area of Science:
- Cardiology
- Cardiovascular Rehabilitation
- Interventional Cardiology
Background:
- Survivors of coronary artery disease (CAD) face risks of recurrent events.
- Cardiac rehabilitation (CR) is established after initial CAD events.
- The benefit of a second CR course (CR × 2) after recurrent CAD events and repeat percutaneous coronary intervention (PCI) remains unclear.
Purpose of the Study:
- To determine the association between CR × 2 and clinical outcomes in patients undergoing repeat PCI.
- To evaluate the impact of repeat cardiac rehabilitation on cardiovascular event rates.
Main Methods:
- Retrospective analysis of 240 patients undergoing repeat PCI at Mayo Clinic (1998-2013).
- Assessed prevalence of CR × 2 among patients with prior CR.
- Used landmark analyses and propensity score adjustment to compare outcomes between CR × 2 and no CR × 2 groups.
Main Results:
- 40% (97/240) of eligible patients participated in CR × 2.
- CR × 2 was associated with significantly lower target lesion revascularization (HR=0.47).
- CR × 2 showed reduced rates of composite endpoints (CV death, MI, TLR) and CV hospitalizations.
Conclusions:
- A second course of CR following repeat PCI is linked to reduced adverse clinical outcomes.
- Findings support existing policies allowing repeat CR for recurrent cardiovascular events.
- Repeat CR may be a valuable strategy for managing patients with recurrent CAD after PCI.
Purpose:
Survivors of coronary artery disease (CAD) events are at risk for repeat events. Although evidence supports cardiac rehabilitation (CR) after an initial CAD event, it is unclear whether a repeat course of CR (CR × 2) is beneficial after a recurrent CAD event. The purpose of this study was to determine the association of CR × 2 with clinical outcomes in persons undergoing repeat percutaneous coronary intervention (PCI).
Methods:
We assessed the prevalence of CR × 2 and its impact on cardiovascular outcomes in individuals who experienced a repeat PCI at the Mayo Clinic hospitals between January 1, 1998, and December 31, 2013. Landmark analyses were used to calculate unadjusted and propensity score adjusted mortality rates and cardiovascular (CV) events rates for patients who underwent CR × 2 compared with those who did not.
Results:
Among 240 individuals who had a repeat PCI and who had participated in CR after their first PCI, 97 (40%) participated in CR × 2. Outcomes were assessed for a mean follow-up time of 7.8 yr (IQR 7.1-9.0 yr). Propensity score-based inverse probability weighting analysis revealed that CR × 2 was associated with significantly lower target lesion revascularization (HR = 0.47: 95% CI, 0.26-0.86; P = .014), lower combined end point of CV death, myocardial infarction, and target lesion revascularization (HR = 0.57: 95% CI, 0.36-0.89; P = .014), and lower CV hospitalization (HR = 0.60; 95% CI, 0.43-0.84; P = .003).
Conclusion:
A second course of CR following repeat PCI is associated with a lower risk of adverse clinical outcomes. These findings support current policies that allow for repeat courses of CR following recurrent CV events.
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