Randomized Trial of a Tailored Exercise Protocol Versus Standard Cardiac Rehab for Reversing Microvascular Dysfunction Post-Stent
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Background: Coronary microvascular dysfunction may persist after successful percutaneous coronary intervention (PCI) and contribute to incomplete physiological and functional recovery. Individualized exercise rehabilitation may provide greater benefit than conventional rehabilitation. Objective: To compare the effects of a tailored exercise protocol with standard cardiac rehabilitation on coronary microvascular function after PCI. Methods: This two-arm randomized controlled trial included 100 post-PCI patients with documented coronary microvascular dysfunction at a tertiary care hospital in Lahore, Pakistan. Participants were randomized to tailored exercise (n=50) or standard cardiac rehabilitation (n=50) and followed for 12 months. The primary outcome was change in coronary flow reserve (CFR); secondary outcomes included index of microcirculatory resistance (IMR), VO₂peak, flow-mediated dilation (FMD), biochemical markers, and health-related quality of life. Longitudinal outcomes were analyzed using repeated-measures methods with intention-to-treat analysis. Results: CFR increased by 0.76 ± 0.24 in the tailored group versus 0.36 ± 0.22 in controls, yielding a between-group difference of 0.40 (95% CI 0.31–0.49; p<0.001). IMR decreased by 8.5 ± 3.7 versus 4.6 ± 3.1, respectively, with a between-group difference of −3.90 (95% CI −5.26 to −2.54; p<0.001). Greater improvements were also observed in VO₂peak, FMD, nitric oxide, hs-CRP, and physical and emotional quality-of-life domains. No major adverse events were reported. Conclusion: Tailored rehabilitation was associated with greater improvement in coronary microvascular, functional, endothelial, and selected patient-reported outcomes than standard rehabilitation over 12 months
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