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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Exercise training intervention after coronary angioplasty: the ETICA trial

Romualdo Belardinelli, MD, FESC^*, Ivana Paolini, PhD, Giovanni Cianci, MD, Roberto Piva, MD, Demetrios Georgiou, MD, FACC^|| and Augusto Purcaro, MD^¶

^* G. M. Lancisi Department of Cardiology and Cardiac Surgery, Division of Cardiology 1, Ancona, Italy
Department of Cardiac Rehabilitation, Division of Cardiology 1, Ancona, Italy
Department of Chemistry, Division of Cardiology 1, Ancona, Italy
Department of Nuclear Medicine, Division of Cardiology 1, Ancona, Italy
^|| Department of Cardiovascular Radiology and Hemodynamics, Division of Cardiology 1, Ancona, Italy
^¶ Columbia University, Department of Medicine, New York, New York, USA

Manuscript received August 14, 2000; revised manuscript received January 26, 2001, accepted February 12, 2001.

Reprint requests and correspondence: Dr. Romualdo Belardinelli, Via Rismondo, 5-60100 Ancona, Italy.
r.belardinelli{at}fastnet.it

OBJECTIVES

The goal of this study was to determine the effects of exercise training (ET) on functional capacity and quality of life (QOL) in patients who received percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting (CS), the effects on the restenosis rate and the outcome.

BACKGROUND

It is unknown whether ET induces beneficial effects after coronary angioplasty.

METHODS

We studied 118 consecutive patients with coronary artery disease (mean age 57 ± 10 years) who underwent PTCA or CS on one (69%) or two (31%) native epicardial coronary arteries. Patients were randomized into two matched groups. Group T (n = 59) was exercised three times a week for six months at 60% of peak O₂. Group C (n = 59) was the control group.

RESULTS

Only trained patients had significant improvements in peak O₂ (26%, p < 0.001) and quality of life (26.8%, p = 0.001 vs. C). The angiographic restenosis rate was unaffected by ET (T: 29%; C: 33%, P = NS) and was not significantly different after PTCA or CS. However, residual diameter stenosis was lower in trained patients (–29.7%, p = 0.045). In patients with angiographic restenosis, thallium uptake improved only in group T (19%; p < 0.001). During the follow-up (33 ± 7 months) trained patients had a significantly lower event rate than controls (11.9 vs. 32.2%, RR: 0.71, 95% confidence interval [CI]: 0.60 to 0.91, p = 0.008) and a lower rate of hospital readmission (18.6 vs. 46%, RR: 0.69, 95% CI: 0.55 to 0.93, p < 0.001).

CONCLUSIONS

Moderate ET improves functional capacity and QOL after PTCA or CS. During the follow-up, trained patients had fewer events and a lower hospital readmission rate than controls, despite an unchanged restenosis rate.

Abbreviations and Acronyms   AMI = acute myocardial infarction   BP = blood pressure   CA = coronary angioplasty   CABG = coronary artery bypass surgery   CAD = coronary artery disease   CI = confidence interval   CS = coronary stenting   ET = exercise training   LV = left ventricle, left ventricular   MET = metabolic equivalent   PTCA = percutaneous transluminal coronary angioplasty   QOL = quality of life   RR = relative risk   O2 = oxygen uptake

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