Safety and Outcomes of Cardiac Rehabilitation for Patients with Spontaneous Coronary Artery Dissection

OBJECTIVE: To evaluate the safety and outcomes of aerobic and resistance training in patients undergoing cardiac rehabilitation after spontaneous coronary artery dissection. METHODS: Eleven patients with spontaneous coronary artery dissection at 2 academic centres were studied retrospectively during cardiac rehabilitation from July 2013 to September 2017. Patients underwent maximal effort exercise testing at enrollment and discharge per institutional protocol. Patients were prescribed individualized exercise regimens based on stress test results, stress management with a behavioural psychologist, and diet counselling with a nutritionist. Resistance training was introduced during weeks 3-5 with close blood pressure monitoring. RESULTS: Ten patients who completed cardiac rehabilitation showed improvements in aerobic exercise capacity and exercise duration. For resistance training, patients increased the total number of resistance exercise modalities, repetitions, or both. After cardiac rehabilitation, significant improvements were found in exercise capacity, Mental Composite Score, Physical Composite Score, anxiety measured by Generalied Anxiety Disorders (GAD-7), and positive affect. During a mean followup of 14 months, no patients had any recurrent dissection or major adverse cardiac events. CONCLUSION: Cardiac rehabilitation is safe and improves functional status, anxiety, positive affect and quality of life in patients with spontaneous coronary artery dissection. Future studies should explore ways to further improve the psychosocial and functional status of these patients.