Exercise Training for Patients After Coronary Artery Bypass Grafting Surgery

Abstract

Patients with coronary artery disease (CAD) who suffer persistent symptoms and reduced quality of life while receiving medical therapy are considered for revascularization.1 Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the most common methods of revascularization for symptomatic CAD. These two interventions can reduce ischemic symptoms such as angina or dyspnea,2 thus improving the ability to undertake physical training. Shorter length of hospitalization,3 earlier return to work,4 and better life adaptation5 were reported in patients undergoing PCI. However, the incidence rate of restenosis following PCI is higher than CABG,6 and PCI patients who required further interventions outnumbered the patients who underwent CABG.7-8 A recent meta-analysis study found that the mortality rate and the rate of revascularization were significantly lower in the CABG group than the PCI group (9.9% vs 24.5%).9 In a subgroup analysis, the 5-year mortality rate of DM patients was also lower in the CABG group. In the era of drug-eluting stent (DES), the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial10 found that major adverse cardiovascular events rates at 12 months were significantly higher in the PCI group (17.8% vs 12.4%), and the rate of revascularization was lower in the CABG group (5.9% vs 13.5%), but stroke was significantly higher in the CABG group (2.2% vs 0.6%). However, the application of new surgical technique, such as off-pump CABG (OPCAB) may reduce the rate of stroke after surgery. In general, CABG remains the method of choice in patients with left main disease, multivessel disease, especially in diabetic patients, or patients with left ventricular dysfunction, in the event of failure of PCI, and in-stent restenosis.11 Although the procedure risk is higher for patients receiving CABG, the extent of revascularization is more complete,12 and hence the potential of training is higher than patients with PCI. The objective of this study is to review the effect of exercise training program in patients with CABG.