Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease -: A randomized trial

Background - Regular exercise in patients with stable coronary artery disease has been shown to improve myocardial perfusion and to retard disease progression. We therefore conducted a randomized study to compare the effects of exercise training versus standard percutaneous coronary intervention (PCI) with stenting on clinical symptoms, angina-free exercise capacity, myocardial perfusion, cost-effectiveness, and frequency of a combined clinical end point ( death of cardiac cause, stroke, CABG, angioplasty, acute myocardial infarction, and worsening angina with objective evidence resulting in hospitalization). Methods and Results - A total of 101 male patients aged less than or equal to 70 years were recruited after routine coronary angiography and randomized to 12 months of exercise training ( 20 minutes of bicycle ergometry per day) or to PCI. Cost efficiency was calculated as the average expense ( in US dollars) needed to improve the Canadian Cardiovascular Society class by 1 class. Exercise training was associated with a higher event-free survival ( 88% versus 70% in the PCI group, P = 0.023) and increased maximal oxygen uptake ( + 16%, from 22.7 +/- 0.7 to 26.2 +/- 0.8 mL O-2/kg, P < 0.001 versus baseline, P < 0.001 versus PCI group after 12 months). To gain 1 Canadian Cardiovascular Society class, $ 6956 was spent in the PCI group versus $ 3429 in the training group ( P < 0.001). Conclusions - Compared with PCI, a 12-month program of regular physical exercise in selected patients with stable coronary artery disease resulted in superior event-free survival and exercise capacity at lower costs, notably owing to reduced rehospitalizations and repeat revascularizations.