Data from over 18,000 patients show a reduced risk of mortality, hospital admissions and other conditions. The researchers emphasize that these figures give a first indication, and that follow-up research is needed.
Stable or chronic chest pain (angina pectoris) is usually caused by a local stenosis, i.e., narrowing of an artery, in one or more coronary arteries. This narrowing causes the heart to receive too little blood, which may lead to the symptoms of chest pain. These symptoms mainly occur when the heart needs more oxygen, for example during exercise. If medication does not work (or no longer works) sufficiently, an operation often follows in which doctors place a stent; a hollow tube of gauze at the place of the stenosis, preventing the narrowing from returning there.
The researchers wondered whether surgery is a good treatment method for stable chest pain. "We already knew that little engagement in exercise training increases the risk of cardiovascular disease," says Dick Thijssen, a physiologist at Radboudumc and principal investigator. "People with heart problems generally engage in less exercise training than people without heart problems. We wanted to find out whether following an exercise program aimed at cardiac rehabilitation could help in reducing their complaints and improve outcomes."
Differences between surgery and exercise program
They compared data from over 18,000 patients diagnosed with stable angina pectoris, or chest pain due to narrowed coronary arteries. They also examined the patients 18 months later. The relative numbers of deaths, hospital admissions and new conditions were lower among patients undergoing cardiac rehabilitation than among operated patients. "With this study, we wanted to better understand the role that an exercise program can play in these patients with chronic chest pain. It does indeed seem to be a good alternative," says Thijssen.
Follow-up study on best treatment
This study used a large, already existing database, in which the data of patients were examined afterwards. Therefore, according to Thijssen, new research is needed in which two new groups are compared. Thijssen: "The Radboudumc and the Maxima Medisch Centrum will soon be starting a new study in which we will compare patients with chronic chest pain who are undergoing surgery versus patients who are undergoing cardiac rehabilitation. With the results, we hope to be able to say which treatment is best, and for whom. One patient may benefit more from an intensive exercise program, while another may be better off undergoing surgery.
About the publication in European Journal of Preventive Cardiology
Exercise-based cardiac rehabilitation versus percutaneous coronary intervention for chronic coronary syndrome: Impact on morbidity and mortality – Benjamin J.R. Buckley, Iris A. de Koning, Stephanie L. Harrison, Elnara Fazio-Eynullayeva, Paula Underhille, Hareld M.C. Kemps, Gregory Y.H. Lip, Dick H.J. Thijssen.