Risk-scoring model to predict one-year major adverse cardiac events after percutaneous coronary intervention

Background: The aim of the present study was to develop a scoring system for predicting 1-year major adverse cardiac events [MACE], including mortality, target vessel or target lesion revascularization, coronary artery bypass graft surgery, and non-fatal myocardial infarction after percutaneous coronary intervention [PCI]

Methods: The data were extracted from a single center PCI registry. The score was created based on the clinical, procedural, and laboratory characteristics of 8206 patients who underwent PCI between April 2004 and October 2009. Consecutive patients undergoing PCI between November 2009 and February 2011 [n= 2875] were included as a validation data set

Results: Diabetes mellitus, increase in the creatinine level, decrease in the left ventricular ejection fraction, presentation with the acute coronary syndrome, number of diseased vessels, primary PCI, PCI on the left anterior descending artery and saphenous vein graft, and stent type and diameter were identified as the predictors of the outcome and used to develop the score [R[²] = 0.795]. The models had adequate goodness of fit [Hosmer-Lemeshow statistic; p value = 0.601] and acceptable ability of discrimination [c-statistics = 0.63]. The score categorized the individual patients as low-, moderate-, and high-risk for the occurrence of MACE. The validation of the model indicated a good agreement between the observed and expected risks

Conclusion: An individual risk-scoring system based on both clinical and procedural variables can be used conveniently to predict 1-year MACE after PCI. Risk classification based on this score can assist physicians in decision-making and postprocedural health care

Opium consumption and mid-term outcome of percutaneous coronary intervention in men

Controversy persists over the potential benefits/harms of opium consumption in coronary heart disease. This study investigated the association between 12 months' major adverse cardiac events [MACE] and pre-procedural opium consumption among patients undergoing percutaneous coronary intervention [PCI]. Retrospectively, 1545 consecutive men who underwent PCI between 21[st] June 2009 and 20[th] June 2010 at Tehran Heart Center and were registered in the PCI Databank were entered into this cohort study. The occurrence of MACE, defined as cardiac death, non-fatal myocardial infarction, and need for target vessel revascularization [TVR] or target lesion revascularization [TLR], was compared between two groups of opium consumers and non-consumers in 350 [22.7%] patients. Sixty-four [0.86%] patients expired within 12 months. After adjustment for potential confounders, analysis revealed that opium consumption had no significant relationship with 12 months' MACE [11[3.1%] vs. 53[4.4%]; p value = 0.286, among opium users vs. non users, respectively]. Furthermore, the different components of MACE, including target vessel revascularization, target lesion revascularization, coronary artery bypass graft, and non-fatal myocardial infarction, were not significantly related to opium use. Pre-procedural opium usage in patients undergoing PCI was not associated with 12 months' MACE

Endovascular repair of supra-celiac and abdominal aortic pseudo aneurysms concomitant with a right atrial mass in a patient with behcet's disease: a case report

Behcet's disease is a rare immune mediated systemic vasculitis which besides it's more frequent involvement of eyes and skin, sometimes present with aortic pseudo aneurysm and more rarely cardiac inflammatory masses. A 51-year-old patient with Behcet's Disease presented with two symptomatic aortic pseudoaneurysms concomitant with a right atrial mass. Computed tomography [CT] revealed one supra-celiac and another infrarenal aortic pseudoaneurysms. Echocardiography showed a large mobile mass in the right atrium. Both pseudoaneurysms were successfully excluded simultaneously via endovascular approach with Zenith stent-grafts, and the atrial mass was surgically removed 10 days later. Post-implant CT showed successful exclusion of both pseudo-aneurysms, patency of all relevant arteries, and patient is now asymptomatic and has returned to normal lifestyle. Multiple pseudoaneurysms concomitant with a right atrial mass can be an initial manifestation of Behcet's disease. Endovascular repair can be a good treatment option for the pseudoaneurysms

Percutaneous mitral valve repair with the edge-to-edge technique: case series of first Iranian experience

Mitral regurgitation [MR] is a common valvular lesion in the general population with considerable impact on mortality and morbidity. The MitraClip System [Abbot Laboratories, Abbot Park, IL, USA] is a novel percutaneous approach for treating MR which involves mechanical edge-to-edge coaptation of the mitral leaflets. We present our initial experience with the MitraClip System in 5 patients. In our series, the cause of MR was both degenerative and functional. Two patients received two MitraClips due to unsatisfactory results after the implantation of the first clip. Acute procedural success was seen in 4 patients. Blood transfusion was required for 2 patients. All the patients, except one, reported improvement in functional status during a 2-month follow-up period. Our initial experience with MitraClip implantation indicates that the technique seems feasible and promising with acceptable results and that it could be offered to a broader group of patients in the near future

Mid-term follow-up of drug-eluting stenting for in-stent restenosis: bare-metal stents versus drug-eluting stents

Despite major advances in percutaneous coronary intervention [PCI], in-stent restenosis [ISR] remains a therapeutic challenge. We sought to compare the mid-term clinical outcomes after treatment with repeat drug-eluting stent [DES] implantation [[DES sandwich] technique] with DES placement in the bare-metal stent [DES-in-BMS] in a [real world] setting. We retrospectively identified and analyzed clinical and angiographic data on 194 patients previously treated with the DES who underwent repeat PCI for ISR with a DES or a BMS. ISR was defined, by visual assessment, as a luminal stenosis greater than 50% within the stent or within 5 mm of its edges. We recorded the occurrence of major adverse cardiac events [MACE], defined as cardiac death, non-fatal myocardial infarction, and the need for target vessel revascularization [TVR]. Of the 194 study participants, 130 were men [67.0%] and the mean +/- SD of age was 5 7.0 +/- 10.4 years, ranging from 37 to 80 years. In-hospital events [death and Q-wave myocardial infarction] occurred at a similar frequency in both groups. Outcomes at twelve months were also similar between the groups with cumulative clinical MACE at one-year follow-up of 9.6% and 11.3% in the DES-in-BMS and the DES-in-DES groups, respectively [p value = 0.702]. Although not significant, there was a trend toward a higher TVR rate in the intra-DES ISR group as compared to the intra-BMS ISR group [0.9% BMS vs. 5.2% DES; pvalue = 0.16]. Our study suggests that the outcome of the patients presenting with ISR did not seem to be different between the two groups of DES-in-DES and DES-in-BMS at one-year follow-up, except for a trend toward more frequent TVR in the DES-in-DES group. Repeat DES implantation for DES restenosis could be feasible and safe with a relatively low incidence of MACE at mid-term follow-up

Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on mortality of coronary artery bypass grafting

There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs] as regards the postoperative mortality of coronary artery bypass grafting [CABG]. This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 [46.38%] patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. The mean age of the patients was 60.04 +/- 9.51 years and 7364 [73.23%] were male. Eighty-seven [0.86%] patients expired within 30 days. Multivariate analysis revealed that the administration of ACEI/ARB significantly protected against in-hospital deaths in as much as there were 33 [0.70%] vs. 54 [1.0%] deaths in the ACEI/ARB positive and negative groups, respectively [OR: 0.628; p value = 0.09]. Patients without ACEI/ARB were more likely to have a higher global ejection fraction. Preoperative ACEI usage in patients undergoing CABG can be associated with decreased in-hospital mortality. Large-scale randomized clinical trials are suggested

Retrograde trans-femoral approach for successful percutaneous angioplasty in a diabetic patient with ischemic hand ulcer: a case report

Hand ischemia is a rare complication of diabetes and some other chronic vascular diseases. Critical hand ischemia causes painful limbs and disability and requires urgent revascularization. There have been a few reports of successful trans-brachial percutaneous angioplasty in the upper extremity in the radial or ulnar artery. Herein, we report the results of the endovascular treatment of a 68-year-old diabetic patient with an ischemic hand ulcer due to the severe stenotic lesions of the infra-brachial arteries. The patient underwent successful angioplasty via the retrograde trans-femoral technique to avoid the drawbacks. At the first week of post-procedural follow-up, the patient's finger was warm with a well-healing wound and reduced pain. In the next two months, he had no complaint of pain or active ulceration; the ulcer was well healed, and the hand was warm. The present case shows that history taking and physical examination should be followed by upper-extremity arteriography for the evaluation of hand ischemia. The trans-femoral approach enabled us to perform percutaneous catheterization for both diagnostic and interventional purposes. Not only is this strategy useful even for the severe stenotic disease of the distal parts of below-the-elbow arteries but also it avoids the unpleasant complications of antegrade brachial cannulation

Endovascular treatment of isolated bilateral internal iliac artery aneurysms with a branched endograft: a case report

Isolated bilateral internal iliac artery [IIA] aneurysm is a rare and potentially lethal disease. Endovascular repair of this disorder is a matter of debate. A symptomatic 68-year-old male presented with severe pelvic pains. Computed tomography revealed a leaking 46-mm aneurysm in the right IIA, a 27-mm aneurysm in the left IIA, and ectatic changes at a diameter of 31 mm in the right common iliac artery [CIA]. Due to lower rates of morbidity and mortality, an endovascular approach was chosen instead of open surgical repair. However, due to anatomical constraints, an endograft had to be implanted in a healthy aorta in order to support an iliac branch endograft in the left CIA. Subsequently, following coil embolization of the left IIA, an iliac stent graft was extended to the right external iliac artery [EIA]. Two-year follow-up CT imaging showed complete exclusion of all the aneurysms and patency of the pelvic visceral arteries. The patient is currently asymptomatic. Endovascular repair of bilateral isolated IIAs can be a feasible treatment option. However, due to the limited availability of sizes in iliac branch devices currently on the market, a main body device is sometimes required to be deployed in a healthy aorta for additional endograft support

Effectiveness of two-year versus one-year use of dual antiplatelet therapy in reducing the risk of very late stent thrombosis after drug-eluting stent implantation

Impact of 12 months' versus 24 months' use of dual antiplatelet therapy on the prevalence of stent thrombosis in patients undergoing percutaneous coronary intervention [PCI] with the drug-eluting stent [DES] is not clear. As a result, duration of dual antiplatelet therapy is still under debate among interventionists. From March 2007 until August 2008, all consecutive patients with successful PCI who received at least one DES and were treated with dual antiplatelet therapy [Clopidogrel + Aspirin] were included. All the patients were followed up for more than 24 months [mean = 35.27 +/- 6.91 months] and surveyed for very late stent thrombosis and major cardiovascular events. From 961 patients eligible for the study, 399 [42%] discontinued Clopidogrel after 12 months and 562 [58%] continued Clopidogrel for 24 months. The clinical and procedural variables were compared between the two groups. In the 12 months' use group, two cases of definite thrombosis occurred at 18 and 13 months post PCI. In the 24 months' use group, 2 cases of definite thrombosis occurred at 14 and 28 months post PCI, one of them with stenting in a bifurcation lesion. Five cases of probable stent thrombosis were detected at 21, 28, 32, 33, and 34 months after the procedure. It is of note that amongst the 10 cases of stent thrombosis, only 1[10%] thrombosis occurred when the patient was on Clopidogrel and Aspirin and all the other 9 [90%] cases of thrombosis appeared after the discontinuation of the dual antiplatelet therapy. Extended use of dual antiplatelet therapy [for more than 12 months] was not significantly more effective than Aspirin monotherapy in reducing the risk of myocardial infarction or stent thrombosis, death from cardiac cause, and stroke

Impact of side-branch flow in coronary bifurcation intervention

The optimal strategy in percutaneous coronary intervention [PCI] for coronary artery bifurcation lesions has yet to be agreed upon. We compared a strategy for stenting the main vessel to provide a complete perfusion flow in the side branch, namely thrombolysis in myocardial infarction [TIMI] - III, with a strategy for intervention in both the main vessel and the side branch [MV + SB]. This retrospective study utilized data on 258 consecutive patients with bifurcation lesions scheduled for PCI at Tehran Heart Center between March 2003 and March 2008. The patients were followed up for 12 months, and the primary end point was a major adverse cardiac event [MACE], i.e. cardiac death, myocardial infarction, target-vessel revascularization, and target-lesion revascularization during the 12-month follow-up period. A total of 52.7% of the patients underwent PCI on the main vessel of the bifurcation lesions [MV group] and 47.3% with a similar lesion type received a percutaneous intervention on both the main vessel and the side branch [MV + SB group]. The total rate of MACE during the follow-up was 4.3% [11 patients]; the rate was not significantly different between the MV and MV + SB groups [3.7% vs. 4.9%, respectively; p value = 0.622]. There was no association between MACE in performing a simple or complex interventional strategy to treat coronary bifurcation lesions when drawing the TIMI- III flow as a goal in a simple technique.

Women and coronary artery disease. Part I: basic considerations

Women die of cardiovascular disorders even more than a combination of breast cancer, stroke, chronic obstructive pulmonary disease, and lung cancer. Recent data show that while 1 out of 2.6 women die of coronary artery disease [CAD], only 1 out of 4.6 die from cancer. Whereas some studies show an increase in the age-adjusted mortality of CAD in both women and men, some other studies report an increase in mortality amongst young women. There is a significant decrease in sudden cardiac death in men without significant change in women, and more women die of CAD before their arrival at the emergency room of hospitals than do men. It is, therefore, regrettable that many women and their physicians are not sufficiently aware of the problem and this unawareness is believed to be a major culprit for the existing gender disparities and inaction on the part of women as regards risk modification. What is more, the bulk of our knowledge, preventive measures, diagnostic strategies, and treatment plans are on the basis of studies conducted chiefly in men, when powerful evidence-based gender-specific recommendations call for efforts to enroll more women in order to reach a desirable level of sex representation. Given the significance of CAD assessment in women, it is essential that an acceptable risk score system be devised to estimate the risk of coronary events. The Framingham Risk Score, which has been used for this purpose for a long time, is no longer suitable for women and the Reynolds Risk Score seems to be a more appropriate tool. Finally, from a pathophysiological point of view, endothelial and microvascular dysfunctions are the most salient contributors to the development of CAD in women by comparison with men and they give rise to non-obstructive CAD. Lamentably, most of the relevant studies conducted hitherto have focused predominantly on men; any attempt to redress the balance would be of great value in the endeavors to decrease the risk in women

Success rate, procedural complications and clinical outcomes of coronary interventions in octogenarians: a case-control study

Clinical trials of revascularization have routinely under-enrolled elderly subjects. Thus, symptom relief and improved survival might not apply to elderly patients, in whom the risk of mortality and disability from revascularization procedures seems to be high and co-morbidity is more prevalent. The present case control study was performed to draw a comparison in terms of the procedural success, procedural and in-hospital complications, and major adverse cardiac events [MACE] in a one-year follow-up of octogenarians [age >/= 80 years] with a selected matched younger control group in the Tehran Heart Center Angioplasty Registry. According to the Tehran Heart Center Interventional Registry of 9, 250 patients with a minimum follow-up period of one year between April 1993 and February 2010, 157 percutaneous coronary intervention [PCI] procedures were performed in 112 octogenarians. Additionally, 336 younger patients [459 PCI procedures] were selected from the database as the propensity-score matched controls. There were 147 [93.6%] and 441 [96.1%] successful PCI procedures in the elderly group and control group, respectively [p value = 0.204]. Procedural complications were seen in 5 [3.2%] of the elderly group and 16 [3.5%] of the control group [p value = 0.858]. Totally, 7 [6.3%] in-hospital complications occurred in the elderly group and 22 [6.8%] in the control group [p value = 0.866]. One-year MACE was seen in 9 [9.1%] of the elderly and 18 [5.8%] of the control group [p value = 0.26]. Procedural success and complications, in-hospital complications, and one-year MACE were not significantly different between our two study groups. Therefore, age alone should not be used as the sole criterion when considering revascularization procedures. Furthermore, PCI should not be refused in octogenarians if indicated

One-year clinical outcomes of ultra long apollo polymer-based paclitaxel-eluting stents in patients with complex, long coronary artery lesions

For all the wealth of research comparing the efficacy of the different types of the drug-eluting stent [DES] such as sirolimus-, paclitaxel-, and zotarolimus-eluting stents, there is still a dearth of data on the different brands of each DES type. We aimed to investigate the one-year clinical outcomes, including major adverse cardiac events [MACE], of the use of the ultra long Apollo paclitaxel-eluting stent in patients with long atherosclerotic coronary artery lesions. According to a retrospective review of the Tehran Heart Center Registry of Interventional Cardiology, a single-center nonrandomized computerized data registry in which all adult patients who undergo single or multi-vessel percutaneous coronary intervention [PCI] are enrolled without any specific exclusion criteria, the mixed use of long Apollo paclitaxel-eluting stents and other types of the DES as well as myocardial infarction within forty-eight hours prior to the procedure was excluded. In total, 122 patients were enrolled in the study, and their baseline clinical, angiographic, and procedural characteristics were obtained. In addition, the patients' follow-up data and, most importantly, MACE during a one-year period after intervention were recorded. The mean follow-up duration was 14.1 +/- 3.8 months. The one-year clinical follow-up data were obtained in 95.9% of all the patients. The incidence of MACE was 5.7% during the entire study period. There was 1 death, which occurred during the initial days after PCI. The incidence of non-fatal myocardial infarction was 2.5% [3 cases], including one patient who underwent target vessel revascularization seven months later. Also, 3 patients with single-vessel disease and in-stent restenosis underwent coronary artery bypass grafting between five to ten months later. Our results showed that the Apollo paclitaxel-eluting stent might be regarded as a safe and effective treatment for long coronary lesions

Outcomes of percutaneous coronary intervention on saphenous vein graft and native coronary vessels

The optimal target for revascularization in patients with history of coronary artery bypass graft surgery [CABG] is unclear. This study was designed to compare the outcome of percutaneous coronary intervention [PCI] on saphenous vein grafts [SVG] and that on native vessels in patients with previous CABG in terms of major adverse cardiac events [MACE]. The study drew upon data on consecutive patients hospitalized for PCI and MACE rate during a nine-month follow- up period. The patients were divided according to the target vessel for PCI into two groups: SVG and native vessel. Between 2003 and 2007, 226 patients underwent PCI 6.57 +/- 4.55 years after CABG. Their mean age was 59.52 +/- 9.38 years, and 176 [77.9%] were male. PCI was performed on the SVG in 63 [27.9%] patients and on the native coronary artery in the rest. During a nine-month follow-up period, 9 [4%] patients suffered MACE; the prevalence of MACE was not significantly different between the SVG group [4.8%] and the native vessel group [4.9%], [p value = 0.999]. PCI on grafted and native vessels did not affect MACE in patients undergoing PCI after CABG

Carotid artery stenting, endarterectomy, or medical treatment alone: the debaste is not over

The management of carotid artery stenosis reduces the risk of stroke and its related deaths. Management options include risk factor modification and medical therapy, carotid endarterectomy [CEA], and carotid artery stenting [CAS]. Although several randomized controlled trials [RCTs], mostly conducted in late-1980s and mi-1990s, have proved CEA to be effective in the prevention of ipsilateral ischemic events in selected patients with carotid artery stenosis, aggressive risk factor modification and medical therapy with recently introduced antiplatelet agents, statins, and more effective antihypertensive medications may have reduced compelling indications for immediate surgery in asymptomatic populations. Also recently, due to improvements in percutaneous techniques and carotid stents, CAS has received wide attention as a potential alternative to CEA. Herein, we review the recent data on the management options of carotid artery stenosis and seek to identify the most appropriate treatment strategy in selected patients with carotid artery stenosis

Transcatheter closure of patent ductus arteriosus: initial study on echocardiographic estimation of device size

Transcatheter occlusion of the patent ductus arteriosus [PDA] is a minimally invasive treatment. The appropriate device size is chosen based on the angiographic measurement of the PDA. The current study aimed to assess the relationship between the transthoracic echocardiographic [TTE] measurements of the PDA prior to the occlusion procedure and the actual size of the deployed device. We reviewed the available records of 7 patients [2 male] who underwent the procedure at our institution [mean age: 21 +/- 12.7years, range: 7 to 46years]. PDA closure was performed successfully using the Amplatzer Duct Occluder [n = 5] and its Chinese copycat, Cardi-O-Fix Occluder [n =2]. The TTE measurement of the aortic end diameter of the PDA showed a good linear regression correlation with the size of the implanted duct occluder [duct occluder size = 0.543 + [0.941 x TTE measured diameter], R = 0.907; p value

Measurement of atrial septal defect size: a comparative study between transesophageal echocardiography and balloon occlusive diameter method

Transcatheter closure of atrial septal defect secundum [ASD-II] has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography [TEE] method for measuring atrial septal defect with balloon occlusive diameter [BOD] in transcatheter ASD-II closure. A total of 39 patients [71.1% female, mean age: 35.31 +/- 15.37 years] who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography [TTE] and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1-2 mm larger than the BOD of the defect. The mean defect size obtained by TEE and BOD was 18.50 +/- 5.08 mm and 22.86 +/- 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 +/- 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD=0.773 ASD size by TEE+8.562; r2=67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values [r=-0.394, p value=0.013]. In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure

Tricuspid regurgitation improvement in relation to the amount of pulmonary artery pressure reduction

Given the common concomitance of tricuspid regurgitation [TR] with significant mitral stenosis, we aimed at exploring the relation between TR severity and pulmonary artery hypertension [PAH] in patients who underwent mitral balloon valvotomy [MBV]. We analyzed the echocardiography data of 133 consecutive patients [82.0% female, mean age 44.68 +/- 12.56 years] with different degrees of TR severity that underwent MBV between April 2006 and March 2008. The pulmonary artery systolic pressure [PAPs] > 35 mmHg was considered as PAH. Before MBV, 36.20% of the patients had moderate to severe TR, 92.5% PAH, and 18.0% right ventricular [RV] dilation [RV dimension >/= 33 mm]. After MBV, TR severity improved in 41.4%, worsened in 8.3%, and did not change in 50.4%. Before and after MBV, PAPs was significantly correlated with TR severity, and the mean PAPs change in patients with improved TR was significantly more than that of patients without TR improvement [p value=0.042]. Tricuspid regurgitation severity and mean PAPs [from 52.83 +/- 18.82 to 35.89 +/- 9.39 mmHg] decreased significantly after MBV [both p values < 0.001]; this reduction was significantly correlated to the amount of PAPs decrease. A cut-off point of >/= 19 mmHg reduction in PAPs had a specificity of 71.79% and sensitivity of 52.73% to show TR severity improvement [by Receiver-Operative-Characteristics analysis]. The mean of RV dimension decreased from 28.94 +/- 5.43 to 27.95 +/- 4.67 mm [p value < 0.001]. In contrast to patients with RV dilation, TR reduced significantly in patients without RV dilation [p value < 0.001]. Improvement in TR severity was directly correlated with the amount of PAPs reduction after MBV. More studies are needed to better define a cut-off value for PAPs reduction related to TR severity improvement

Significant improvement in severely stunned left ventricle after percutaneous coronary intervention

This is a case of severely stunned left ventricle which occurred after a non-ST elevation myocardial infarction in a 76-year-old woman who was a known case of three-vessel disease. Her symptoms and cardiac function responded well to revascularization

Effect of cardiac rehabilitation program on heart rate recovery after percutaneous coronary intervention and coronary artery bypass grafting

The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery [HRR] in patients who received percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]. Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program [phase 2] after PCI [n=62] or CABG [n=178] at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR. All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors [except for diabetes mellitus] was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively [p=0.019]. The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality [i.e. PCI or CABG] after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients