PAUSE (PCI Alternative using Sustained Exercise) and COMPARE (Comparison of PCI and Rehabilitation)

We have developed two proposals that are based on the hypothesis that exercise-based rehabilitation is more effective than PCI for treating select patients with stable coronary artery disease. PCI is still widely used in spite of its expense and absence of studies documenting improved survival. Our goal is to apply new technologies to assess the effects of one year of exercise training and lifestyle intervention compared to PCI on coronary anatomy and function, and to compare cost-effectiveness of the two strategies. Prior studies have not had the technology available to accurately measure the effects of rehabilitation on coronary flow, function, and anatomy. With recent advances in imaging (positron emission tomography, ultra fast CT coronary imaging, intravascular ultrasound, and fractional flow reserve), the potential exists to document the effects of exercise training more precisely. Cost effectiveness analyses are designed to compare total health care costs of the widely-used PCI with one year of rehabilitation. Finally, long-term outcomes will be compared between PCI and rehabilitation. Pause is funded by the VA Rehabilitation Service and began November 2012 (Jon Myers, PhD is the PI). Recruitment is ongoing with 8 patients ranomized as of 2013.