[Evaluation of the readaptation of patients with triple coronary vessel disease unfit for by-pass surgery]

Abstract

The objective of this study is to evaluate the effects of rehabilitation in 46 consecutive patients with triple vessel coronary disease, and unfit for by-pass surgery: there were 45 men and 1 woman (mean age = 58 years), admitted during the 3rd week of a myocardial infarction (N = 31) or following unstable angina (N = 15). The stroke volume (SV) is normal in 50 p. cent of the patients, but 15 p. cent presented as SV less than 0.30. 3 patients were unable to start their rehabilitation because of unstable angina (N = 2), or severe pulmonary edema (N = 1). Following 4 weeks of rehabilitation, comparison of the stress tests pre- and post-rehabilitation, reveals improved functional capacities (maximum level reached 103.6 +/- 27 vs 126.4 +/- 31; p less than 0.001, and an improvement of the ischemic threshold (82 +/- 32 vs 92 +/- 31; p less than 0.05). During the long-term follow-up (32.5 months), 4 patients died from cardiac complications (8.7%) and one from extra-cardiac reasons. Among the 41 alive patients, 58.6 p. cent were asymptomatic, 39 p. cent presented cardiac complications, one had a GI malignancy. The rate of return to work among the active population is 68.5 p. cent within a mean time of 1.7 months after rehabilitation. Overall, this study demonstrates the possibility of cardiac rehabilitation under medical supervision in patients with severe triple vessel coronary disease. The improvement of the functional abilities under stress conditions is obvious, enabling the patient to regain confidence in him/herself and improve his/her comfort.