Effectiveness of cardiac rehabilitation after percutaneous transluminal coronary angioplasty (PTCA)

In several large studies, the effectiveness of cardiac rehabilitation based on physical training (PT) has been studied in patients after percutaneous transluminal coronary angioplasty (PTCA). In the ETICA study (Execise Training Intervention after Coronary Angioplasty), the effect of PT on clinical outcomes was studied in 118 patients who underwent PTCA with one CA (n = 81) or two CA (n = 37).

Patients were randomized to the group in which they performed FT, and the group of routine practice. Physical training (FT) (3 times a week for 6 months) consisted of physical exertion (FN) on an exercise bike (30 min) and gymnastics (15 min). At the beginning and at the end of the study, a stress test was carried out, the stopping criteria for which were patient fatigue, the achievement of the target heart rate or ST-segment depression> 1 mm.

Indicators of VO2max and quality of life increased by 26% (p <0.001) only in the FT group. The frequency of angiographically confirmed CA restenoses (narrowing> 50%) for 6 months of observation did not differ in the two groups (29% vs 33%), but the intracavitary diameter of the CA at the intervention site in the TF group was 30% higher (p <0.05) .

Progression of the disease and new lesions in large CA (narrowing> 20%) in the TF group were observed much less frequently. Cardiac ischemia, which was assessed by the presence of defects during waist perfusion during myocardial scintigraphy, was also observed less frequently in trained patients. The observation period after the completion of the intervention was 33 ± 7 months. During this time, no deaths occurred in any of the groups, however, in the TF group, AMI (1 vs 3) was less frequently noted (p <0.008) and percutaneous transluminal coronary angioplasty (PTCA) was performed (4 vs 11) or CS ( 2 vs 5).

This study was conducted prior to the widespread use of stents during PTCA and the use of drug-eluting stents. Thus, only 19 patients from the FT group and 18 patients from the control group had stents installed.

In addition, they did not use lipid-lowering therapy because they evaluated the effect of TF on lipid levels. Consequently, it is not clear that PT would have given a similar slowdown in the development of atherosclerosis and a reduction in the frequency of cardiac events if they performed comprehensive modern therapy. In addition, it is not clear to what extent the improvement of the condition of the coronary artery (CA) occurred due to structural changes in atherosclerotic plaques, and to which due to the improvement of endothelial function.

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