title: Beneficial effects of cardiac rehabilitation in patients with incomplete revascularization after primary coronary angioplasty.
abstract: BACKGROUND
  There are no reliable data concerning the safety and benefits of physical rehabilitation in patients with a two-vessel disease before the second stage of angioplasty. The aim of this study was to evaluate the efficiency of early cardiac rehabilitation in patients with acute coronary syndromes and with angiographically significant residual coronary artery stenosis after a successful percutaneous coronary intervention (PCI) into the culprit lesion.
  
  
  METHODS
  Retrospective analysis of the results of coronary angiograms and exercise tests of patients who underwent stationary rehabilitation after their first ACS and first PCI.
  
  
  METHODS
  Cardiac Rehabilitation Department.
  
  
  METHODS
  One hundred ninety patients divided into 2 groups according to the completeness of myocardial revascularization; 49 with significant (≥70%) coronary artery stenosis in a non-culprit vessel, the mean diameter reduction 80±9%; and 141 without any residual stenosis. The prevalence of classical risk factors was comparable in both groups. Rehabilitation was conducted as a stationary 3-week program.
  
  
  METHODS
  Comparison of the initial and final exercise test workload in both groups, as well as the frequency of adverse effects during the program.
  
  
  RESULTS
  Physical training in patients with incomplete revascularization (IR) was safe and well tolerated. Significant increase of workload capacity after the rehabilitation program was observed in both groups: in the IR group from 7.3±3.0 to 8.8±2.9 MET (P<0.0001) and in the complete revascularization (CR) group - from 7.6±2.8 to 9.2±2.9 MET (P<0.0001). No significant difference was observed in initial workload capacities (P=0.9813) nor in final workload capacities (P=0.8571) between the two groups. Two patients in the group with residual lesion (4%) and one in the group without residual lesion (0.7%) required urgent PCI during the rehabilitation program, P=0.1637.
  
  
  CONCLUSIONS
  Early postinfarction physical training is safe and efficient for patients after complete revascularization and for those with untreated non-culprit coronary artery stenosis. Gradual increase in physical training intensity under cardiologist supervision is essential in identifying those rare patients for whom the second stage of angioplasty should not be delayed.
  
  
  CONCLUSIONS
  Our study shows that patients with incomplete revascularization may be qualified for cardiac rehabilitation programs.
authors.affiliation: Department of Cardiology, Medical University of Lodz, Lodz, Poland - tomasz.rechcinski@umed.lodz.pl.
authors.forename: T
authors.initials: T
authors.lastname: Rechciński
authors.forename: M
authors.initials: M
authors.lastname: Kałowski
authors.forename: J D
authors.initials: JD
authors.lastname: Kasprzak
authors.forename: E
authors.initials: E
authors.lastname: Trzos
authors.forename: M
authors.initials: M
authors.lastname: Kurpesa
mesh_terms: D054058:Acute Coronary Syndrome / Q000534:rehabilitation* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000534:rehabilitation* / Q000628:therapy; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D062645:Percutaneous Coronary Intervention; D011044:Poland; D012189:Retrospective Studies