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Cardiac Rehabilitation After Spontaneous Coronary Artery Dissection

Silber, Taryn C. BS; Tweet, Marysia S. MD; Bowman, Melissa J. BS; Hayes, Sharonne N. MD; Squires, Ray W. PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: September/October 2015 - Volume 35 - Issue 5 - p 328–333
doi: 10.1097/HCR.0000000000000111
Brief Report

PURPOSE: Although cardiac rehabilitation (CR) improves outcomes in patients after atherosclerotic myocardial infarctions, little is known of the CR benefit among patients with spontaneous coronary artery dissection (SCAD), who are primarily young, otherwise healthy women. The purpose of this study was to describe SCAD patient outcomes in phase 2 outpatient CR.

METHODS: Patients with SCAD who enrolled in CR were retrospectively identified. Patients participated in standard CR, which included supervised and independent flexibility, stretching, aerobic, and strength training exercises. Patients received counseling regarding nutrition, weight and stress management. Assessments at baseline and program completion included cardiopulmonary exercise testing or 6-Minute Walk Test, body composition using plethysmography, depression (Patient Health Questionnaire-9), and stress (a scale of 1-10) scores.

RESULTS: Nine patients, all women, enrolled in CR an average of 12.3 days (range, 7-21 days) after their SCAD event, with one enrolling again after a recurrence. Cardiac rehabilitation was well received, with participants completing an average of 28 CR sessions (range, 5-39 sessions). Patients did not report cardiac symptoms and there were no adverse events during exercise testing or training. Peak oxygen uptake increased by an average of 18% (n = 4) and 6-minute walk distance increased 22% (n = 4). Average body mass decreased 1.1 kg, fat mass decreased 1.6 kg, and lean mass increased 0.4 kg. Depression and stress scores improved by an average of 2.3 and 1.3 points, respectively.

CONCLUSIONS: Standard CR beginning 1 to 2 weeks after SCAD seems to be feasible and safe and results in improved aerobic capacity, body composition, and measures of depression and stress. Because of these benefits, we recommend that patients with SCAD participate in CR.

Spontaneous coronary artery dissection is a relatively rare cause of myocardial infarction affecting primarily young women. We reported on 9 patients who began cardiac rehabilitation for an average of 12 days after their event, completed 28 sessions, and improved exercise capacity, body composition, and mental health indices.

William Beaumont School of Medicine, Oakland University, Rochester, Michigan (Ms Silber); and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota (Ms Silber, Dr Tweet, Ms Bowman, Dr Hayes, and Dr Squires).

Correspondence: Ray W. Squires, PhD, 200 First St, SW, Rochester, MN 55905 (Squires.Ray@mayo.edu).

The authors declare no conflicts of interest.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.