Exercise program appears to be a good alternative to surgery for chronic chest pain Reduced risk of other conditions, hospitalizations, and mortality

Patients with chronic chest pain may benefit more from following an exercise program than from surgery in which doctors place a stent. Data from over 18,000 patients show a reduced risk of mortality, hospitalizations and other conditions. The researchers emphasize that these figures provide an initial indication, and that follow-up research is needed.

Stable or chronic chest pain (angina pectoris) is usually caused by a local narrowing in one or more coronary arteries. This narrowing causes the heart to receive too little blood, which can cause the symptoms of chest pain. These symptoms occur especially when the heart needs more oxygen, for example during exercise. When medication does not work sufficiently (anymore), an operation often follows in which doctors place a stent; a hollow tube of gauze at the place of the narrowing, which prevents the narrowing from returning there.

The researchers questioned whether surgery is the best treatment option for stable chest pain. "We now know that little exercise increases the risk of cardiovascular disease," says Dick Thijssen, a physiologist at Radboudumc and principal investigator. "People with heart disease generally exercise less than people without heart disease. We wanted to know whether it actually helps this group if they do follow an exercise program aimed at cardiac rehabilitation."

Differences between surgery and training program

They compared data from more than 18,000 patients diagnosed with stable angina pectoris, or chest pain due to narrowed coronary arteries. In doing so, they looked at how the patients fared 18 months later. The relative numbers of deaths, hospitalizations and new conditions were lower among patients who attended cardiac rehabilitation than among operated patients. "With this study, we wanted to better understand the role that an exercise program can play in these patients with chronic chest pain. Indeed, it seems to be a good alternative," Thijssen said.

Follow-up study on best treatment

This study used a large, already existing database, looking at patients' data retrospectively. Therefore, according to Thijssen, new research is needed in which two new groups are compared. Thijssen: "The Radboudumc and the Maxima Medisch Centrum will soon start a new study in which we will compare patients with chronic chest pain who undergo an operation and patients who will follow cardiac rehabilitation. With these results, we can hopefully say which treatment is best, and also for whom. One patient may benefit more from an intensive exercise program, while we may be better off operating on another."

About the publication in European Journal of Preventive Cardiology
Exercise-based cardiac rehabilitation versus percutaneous coronary intervention for chronic coronary syndrome: Impact on morbidity and mortality - Benjamin J.R. Buckley, Iris A. de Koning, Stephanie L. Harrison, Elnara Fazio-Eynullayeva, Paula Underhille, Hareld M.C. Kemps, Gregory Y.H. Lip, Dick H.J. Thijssen.

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