Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial.
BACKGROUND
Regular exercise in patients with stable coronary artery disease has been shown to improve myocardial perfusion and to retard disease progression. We therefore conducted a randomized study to compare the effects of exercise training versus standard percutaneous coronary intervention (PCI) with stenting on clinical symptoms, angina-free exercise capacity, myocardial perfusion, cost-effectiveness, and frequency of a combined clinical end point (death of cardiac cause, stroke, CABG, angioplasty, acute myocardial infarction, and worsening angina with objective evidence resulting in hospitalization).


RESULTS
A total of 101 male patients aged < or =70 years were recruited after routine coronary angiography and randomized to 12 months of exercise training (20 minutes of bicycle ergometry per day) or to PCI. Cost efficiency was calculated as the average expense (in US dollars) needed to improve the Canadian Cardiovascular Society class by 1 class. Exercise training was associated with a higher event-free survival (88% versus 70% in the PCI group, P=0.023) and increased maximal oxygen uptake (+16%, from 22.7+/-0.7 to 26.2+/-0.8 mL O2/kg, P<0.001 versus baseline, P<0.001 versus PCI group after 12 months). To gain 1 Canadian Cardiovascular Society class, 6956 dollars was spent in the PCI group versus 3429 dollars in the training group (P<0.001).


CONCLUSIONS
Compared with PCI, a 12-month program of regular physical exercise in selected patients with stable coronary artery disease resulted in superior event-free survival and exercise capacity at lower costs, notably owing to reduced rehospitalizations and repeat revascularizations.
Universität Leipzig, Herzzentrum GmbH, Klinik für Innere Medizin/Kardiologie, Leipzig, Germany. hamr@medizin.uni-leipzig.de
Rainer
R
Hambrecht
Claudia
C
Walther
Sven
S
Möbius-Winkler
Stephan
S
Gielen
Axel
A
Linke
Katrin
K
Conradi
Sandra
S
Erbs
Regine
R
Kluge
Kai
K
Kendziorra
Osama
O
Sabri
Peter
P
Sick
Gerhard
G
Schuler
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000191:economics / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005080:Exercise Test; D005081:Exercise Therapy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D010101:Oxygen Consumption; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin