Cardiac rehabilitation vs. percutaneous coronary intervention for stable angina pectoris: a retrospective study of effects on major adverse cardiovascular events and associated healthcare costs

An estimated 4.1% of the Western population develops stable angina pectoris (SAP) during life,1 which is currently treated by optimal medical therapy, often followed by revascularization, performed percutaneously [i.e. percutaneous coronary intervention (PCI)] or surgically [i.e. coronary artery bypass grafting (CABG)]. However, recent studies found no superiority of revascularization in SAP patients without left-main stenosis on 1- and 2-year prognoses compared to optimal medical therapy.2,3 A potential alternative, cardiac rehabilitation (CR), demonstrated fewer symptoms4 and adverse advents5 in previous small randomized controlled trials, whilst a recent cohort study showed lower 18-month mortality, rehospitalization, and cardiovascular morbidity compared to PCI.6 More research is required to gain insight into clinical outcomes of CR, but also whether CR represents a cost-effective alternative to revascularization given the lower costs of CR7,8 and large proportion of patients with SAP undergoing PCI.9,10 Therefore, we compared the effects of CR vs. PCI on major adverse cardiovascular events (MACE), new revascularizations, chest pain, and associated healthcare costs over a period of 24 months in patients with SAP.