Effects of Catheterization on Artery Function and Health: When Should Patients Start Exercising Following Their Coronary Intervention?

Abstract

Coronary artery disease (CAD) is a leading cause of death worldwide, and percutaneous transluminal coronary angiography (PTCA) and/or percutaneous coronary intervention (PCI; angioplasty) are commonly used to diagnose and/or treat the obstructed coronaries. Exercise-based rehabilitation is recommended for all CAD patients; however, most guidelines do not specify when exercise training should commence following PTCA and/or PCI. Catheterization can result in arterial dysfunction and acute injury, and given that fact that exercise, particularly at higher intensities, is associated with elevated inflammatory and oxidative stress, endothelial dysfunction and a pro-thrombotic milieu, performing exercise post-PTCA/PCI may transiently elevate the risk of cardiac events. This review aims to summarize extant literature relating to the impacts of coronary interventions on arterial function, including the time-course of recovery and the potential deleterious and/or beneficial impacts of acute versus long-term exercise. The current literature suggests that arterial dysfunction induced by catheterization recovers 4-12 weeks following catheterization. This review proposes that a period of relative arterial vulnerability may exist and exercise during this period may contribute to elevated event susceptibility. We therefore suggest that CAD patients start an exercise-training program between 2 and 4 weeks post-PCI, recognizing that the literature suggest there is a "grey area" for functional recovery between 2-12 weeks post catheterization. The timing of exercise onset should take into consideration the individual characteristics of patients (age, severity of disease, comorbidities) and the intensity, frequency and duration of the exercise prescription.

Exercise-induced vasodilation is not impaired following radial artery catheterization in coronary artery disease patients

“…In any event, the paradoxical constriction of catheterized arteries in response to exercise reported in these studies may contribute to exercise-induced myocardial ischemia postcatheterization (4). Indeed, endothelial damage following catheterization has been proposed as a factor to take into account when considering the optimal time to begin exercise rehabilitation (39).…”

Perceived Determinants of Health-Related Behaviors Among Patients with Coronary Heart Disease After Percutaneous Coronary Intervention: A Longitudinal Qualitative Study

“… 43 , 44 A study has shown that arterial dysfunction caused by catheterization recovers 4–12 weeks later, at this stage, patients are not yet able to fully engage in health behaviors. 45 With the recovery of arterial function, patients gradually adopt health behaviors that bring health benefits and meaning of life to patients. 44 This may be the reason why these determinants emerged in the last two interviews.…”

The Effectiveness of Hand Exercise on Limb Function in Patient Coronary Artery Disease Posttransradial Artery Catheterization: Systematic Review

“…Percutaneous Coronary Intervention (PCI) is one of the therapy treatments that must be used in addition to evaluation for treating obstruction in coronary heart disease (PERKI, 2022). PCI is the most common CAD treatment and one of the most frequently performed medical procedures in the world with 97,376 PCI procedures reported in 2015 (Tryfonos et al, 2019). The European Society of Cardiology's recommendations for PCI in acute coronary syndrome advocate the transradial technique (TRA).…”