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

Document Type : Original Article


Cardiac Rehabilitation and Nuclear Medicine Departments. NMC 20 de Noviembre, México City, México.


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.


  1. Stone GW, Kandzari DE, Mehran R, Colombo A. Percutaneous recanalization of chronically occluded coronary arteries. Circulation 2005; 112: 2364-2372.
  2. Pinak BS.Management of coronary chronic total occlusion. Circulación 2011; 123: 1780-1784
  3. Hoye A, Van Domburgh RT, Sonnenschein K, Serruys PW. Percutaneous coronary intervention for chronic total occlusions: A Thorax center experience 1993-2002. Eur Heart J 2005; 36:2630-2636.
  4. Ariza SA, Teruel L, Di Marco A, Lorente V, Sánchez JC, Sánchez EJ, et al. Valor pronóstico de la oclusión total crónica de una arteria no responsable en el infarto agudo de miocardio tratado con angioplastia primaria, Rev Esp Cardiol. 2014; 67:359-66
  5. Toma A, Gebhard C, Gick M, Ademaj F, Stähli BE, Mashayekhi K, et al. Survival after percutaneous coronary intervention for chronic total occlusion in elderly patients. Euro Intervention 2017;13: e28-e235.
  6. Andrew Kei-Yan Ng, Pinak Bipin Shah, David O Williams. Percutaneous Revascularization of Chronic Total Coronary Occlusion. For Whom? Circ Cardiovasc Interv. 2017;10: e005512.
  7. Maron DJ, Hochman JS, Reynolds HR, Bangalore S, O'Brien SM, Boden WE, et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. New England Journal of Medicine 2020; 382(15): 1395-1407
  8. Montero JM, Ramírez RA, Morales DM, Zarzosa CP, Abraira V. Rehabilitación cardiaca en pacientes con infarto de miocardio. Resultados tras 10 años de seguimiento. Rev Esp Cardiol. 2005; 58: 1181-7.
  9. López JF, Pérez TC, Zeballos PC, Anchique CV, Burdiat G, González K. Consenso de Rehabilitación Cardiovascular y Prevención Secundaria de las Sociedades Interamericana y Sudamericana de Cardiología. Rev Urug Cardiol 2013; 28 (2): 1314-29
  10. Maroto JM. Indicaciones y protocolos actuales de rehabilitación cardíaca. Capítulo 1. In Maroto Montero JM editor. Rehabilitación Cardiaca, 1stEdition, España Sociedad Española de Cardiología 2014, p. 1-113
  11. Chamani J, Moosavi-Movahedi AA, Hakimelahi GH. Structural changes in β-lactoglobulin by conjugation with three different kinds of carboxymethyl cyclodextrins. Thermochim Acta. 2005; 432(1):106-111.
  12. Martínez MM, Garza BF, Laita MS, Ruiz AJ, Herráiz GI, Valls LE, et al. Efectos de la rehabilitación cardiaca en la disfunción microvascular coronaria, Rev Esp Cardiol. 2016: 69 (Supl 1):1169.
  13. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al.  European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart Journal 2016 1;37(29):2315-2381
  14. Giallauria F,Acampa W, Ricci F, Vitelli A, Torella G, Lucci R, et al.Exercise training early after acute myocardial infarction reduces stress-induced hypoperfusion and improves left ventricular function   . Eur J Nucl Med Mol Imaging. 2013; 40 (3): 315-24
  15. Leosco D, Rengo G, Iaccarino G, Golino L, Marchese M, Fortunato F, et al. Exercise promotes angiogenesis and improves -adrenergic receptor signalling in the post-ischaemic failing rat heart. Cardiovasc Res 2008; 78: 385-94.
  16. Smart N, Meyer T, Butterfield J, Faddy S, Passino C, Malfatto G, et al. Individual patient meta-analysis of exercise training effects on systemic brain natriuretic peptide expression in heart failure. Eur J Prev Cardiol 2012; 19: 428-35.
  17. Prescott E, Mikkelsen N, Holdgaard A, Eser P, Marcin T, Wilhelm M, et al. Cardiac rehabilitation in the elderly patient in eight rehabilitation units in Western Europe: Baseline data from the EU-CaRE multicenter observational study. Eur. J. Prev. Cardiol. 2019, 26, 1052–1063
  18. Gunning MG, Walker J, Eastick S, Bomanji JB, Ell PJ, Walker JM, et al.Exercise training following myocardial infarction improves myocardial perfusion assessed by thallium-201 scintigraphy. Int J Cardiol 2002; 84: 233-9.
  19. Gielen S, Schuler G, Adams V.Cardiovascular effects of exercise training: molecular mechanisms. Circulation 2010; 122: 1221-38.
  20. Beigoli S, Hekmat A, Farzanegan F, Darroudi M. Green synthesis of amorphous calcium phosphate nanopowders using Aloe Vera plant extract and assessment of their cytotoxicity and antimicrobial activities. Journal of Sol-Gel Science and Technology. 2021 Jun;98(3):508-16.
  21. Chen YM, Li ZB, Zhu M, Cao YM. Effects of exercise training on left ventricular remodeling in heart failure patients: an updated meta-analysis of randomized controlled trials. Int J Clin Pract. 2012; 66: 782-91
  22. Leon SA, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, et al. Guidelines for cardiac rehabilitation and secondary prevention programs. Circulation 2005;111(3):369-76
  23. Perk J, De Backer G,  Gohlke H,  GrahamI, Reiner Z, Verschuren M, et al.European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Eur. Heart Journal 2012; 33(17):2126