Cardiac Rehabilitation and Secondary Prevention Program effect in Chronic Total Occlusion Percutaneous Coronary Intervention patients

Abstract

Introduction: Chronic Total Coronary Occlusion has a high risk of mortality associated with Acute Coronary Syndrome with significantly ventricular disfunction reflected in functional class patient by intolerance to perform physical effort. The Percutaneous Coronary Intervention is the gold standard approach, but in many patients this procedure is not successful. Cardiac Rehabilitation and Secondary Prevention Programs has showed improve the patient's ability to perform physical effort by its positive effect on endothelial function and promote angiogenesis, increasing the ischemic threshold. We evaluate the Cardiac Rehabilitation and Secondary Prevention program effect on myocardial performance and ischemic profile in successful and unsuccessful Chronic Total Occlusion Percutaneous Coronary Intervention patients.Materials and Methods. A non-randomized clinical trial was conducted in patients with CTCO underwent to Percutaneous Coronary Intervention (PCI). Patients were divided into two groups: 1) With successful PCI and 2) With unsuccessful PCI. All patients underwent a Sestamibi-Dipyridamole cardiac scan and stress test before and after of CRH&SP. The cardiac rehabilitation program considered 4-6 weeks of 5 weekly 30-minute training sessions with aerobic at 70% of Heart Resistance Reserve (HRR), with interspersed 3 weekly strength training sessions, as well as nutritional and Psychiatric group interventions.Results. We evaluated 25 patients with successful PCI (n = 13) and unsuccessful PCI (n = 12). For both groups, the CRH&SP showed significant improvement (p <0.05) in myocardial performance parameters, ischemic profile, and physical effort tolerance, with a Cohen's Delta ≥ 80% in Nuclear Medicine Risk, NYHA functional class, METs reached, oxygen consumption, Myocardial Efficacy Index and Duke Score.Conclusions. The CRH&SP has a high positive effect on ventricular function improvement, myocardial performance, and ischemic profile in patients with Chronic Total Coronary Occlusion.

Keywords

• chronic total occlusion
• secondary prevention
• percutaneous coronary
• interventionism