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The importance of cardiac rehabilitation for patients after PCI

Comment by Paul Dendale, EACPR Cardiac Rehabilitation Section

Impact of Cardiac Rehabilitation on Mortality and
Cardiovascular Events After Percutaneous Coronary Intervention in the Community
Kashish Goel, MBBS; Ryan J. Lennon, MS; R. Thomas Tilbury, MD; Ray W. Squires, PhD; Randal J. Thomas, MD, MS
Circulation. 2011;123:2344-2352

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention
Cardiac rehabilitation
G. N. Levine, et al.
Circulation 2011, 124:2574-2609


This large US study  by Goel et al. confirms the effects of CR on all-cause mortality. This result was present in elective or urgent procedures, in both sexes, and all age groups. The absence of an effect on infarction and revascularisation might seem strange (even though a composite of death, revascularisation and infarction was also reduced by CR).
The difference in follow-up might be one possible explanation (in CR patients recurrent ischemia will more easily be detected and treated by revascularisation), the other is a possible shift from fatal to non-fatal events due to physical training.

This important study underlines the importance of referral of patients after PCI to cardiac rehabilitation: regular exercise and good food might be a powerful way to prevent ischemic events from killing your patient.

The indication for referral of patients after revascularization was already mentioned in the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) "Guidelines on myocardial revascularization".

But now, for the first time, Cardiac rehabilitation is a level of evidence I A indication after revascularisation, according to the new US guidelines on PCI:  “Medically supervised exercise programs (cardiac rehabilitation) should be recommended to patients after PCI, particularly for patients at moderate to high risk for whom supervised exercise training is warranted: level of evidence I A”. This guideline is “based on multiple randomised trials or meta-analyses”. So, let’s have those patients in CR!