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Exercise-based cardiac rehabilitation vs. percutaneous coronary intervention for chronic coronary syndrome: impact on morbidity and mortality.

Buckley, BJR, de Koning, IA, Harrison, SL, Fazio-Eynullayeva, E, Underhill, P, Kemps, HMC, Lip, GYH and Thijssen, DHJ (2021) Exercise-based cardiac rehabilitation vs. percutaneous coronary intervention for chronic coronary syndrome: impact on morbidity and mortality. European Journal of Preventative Cardiology. ISSN 2047-4881

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Abstract

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.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in European Journal of Preventative Cardiology following peer review. The version of record Benjamin J R Buckley, Iris A de Koning, Stephanie L Harrison, Elnara Fazio-Eynullayeva, Paula Underhill, Hareld M C Kemps, Gregory Y H Lip, Dick H J Thijssen, Exercise-based cardiac rehabilitation vs. percutaneous coronary intervention for chronic coronary syndrome: impact on morbidity and mortality, European Journal of Preventive Cardiology, 2021;, zwab191, is available online at: https://dx.doi.org/10.1093/eurjpc/zwab191
Uncontrolled Keywords: Angina; Cardiac rehabilitation; Chronic coronary syndrome; Exercise; Percutaneous coronary intervention; Secondary prevention
Subjects: R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions: Sport & Exercise Sciences
Publisher: SAGE Publications
Related URLs:
Date Deposited: 24 Nov 2021 10:16
Last Modified: 24 Nov 2021 10:16
DOI or Identification number: 10.1093/eurjpc/zwab191
URI: https://researchonline.ljmu.ac.uk/id/eprint/15823

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