Cholid Tri Tjahjono
Brawijaya Cardiovascular Research Center Department Of Cardiology And Vascular Medicine Faculty Of Medicine, Universitas Brawijaya Malang

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Optimizing Cardiac Rehabilitation for Patients with Complex Coronary Disease without Revascularization Afifuddin, Mokhammad; Tjahjono, Cholid Tri; Mayangsari, Veny
Clinical and Research Journal in Internal Medicine Vol. 6 No. 2 (2025): Volume 6 No 2, November 2025
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2025.006.02.10

Abstract

Patients with complex coronary artery disease (CAD) ineligible for revascularization present considerable management challenges and a high ischemic burden. Cardiac rehabilitation (CR), a comprehensive, multidisciplinary intervention, emerges as an essential non-pharmacological therapy. This review synthesizes the principles of CR, focusing on its profound pathophysiological benefits in this specific cohort. Mechanistically, CR confers pleiotropic effects: it enhances endothelial function via the eNOS/NO pathway, mitigates systemic inflammation through myokine regulation, promotes coronary collateralization (HIF-1α/VEGF pathway), and restores autonomic balance (HRV). Furthermore, CR integrates essential psychosocial support to address the high prevalence of depression and anxiety, which are independent risk factors. A primary objective, the improvement of quality of life (QoL), is consistently achieved through reduced anginal symptoms and enhanced functional status. Despite robust clinical and economic evidence demonstrating CR's efficacy in reducing MACE, mortality, and healthcare utilization, significant barriers to referral and adherence persist. Vigilant supervision and protocol adaptations are mandated for high-risk anatomical subsets, such as those with chronic total occlusions or severe left ventricular dysfunction
Co-Authors Adhika Prastya Wikananda Aditya Reza Pratama Adriyawan Widya Nugraha Afifah, Yuri Afifuddin, Mokhammad Alfata, Fandy Hazzy Amanda, Febrina Ambari, Ade Meidian Anandini, Hesti Anggoro Budi Hartopo Anggraeni, Vita Yanti Anjarwani, Setyasih Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Anna Fuji Rahimah Ardani Galih Ardhani Galih Ardhani Galih Ardhia, Jessica Fio Ardian Rizal Ardian Rizal Arif Wicaksono Arif Wicaksono Arifah, Medisa Roro Putri Nur Aris Munandar ZI Arityanti, Dean Aryanugraha, Teguh Ashari, Yordan Wicaksono Astiawati, Tri Ayu Asri Devi Adityawati Ayu Asri Devi Adityawati Badai Bhatara Tiksnadi Bambang Rahardjo Budi Satrijo Budi Satrijo Dadang Hendrawan David Rubiyaktho Dedy Irawan Desandri, Dwita Rian Diah Ivana Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Djanggan Sargowo Dwi Adi Nugroho Dwiputra, Bambang Elvira Sari Dewi Ema Pristi Yunita Ema Pristi Yunita, Ema Pristi Erwan, Nabila Erina Evit Ruspiono Evit Ruspiono Fahmy Rusnanta Fandy Hazzi Alfata Fathurohim, Zainal Febrianora, Mega Firdaus, Achmad Jauhar Fitra, Maha Galih Prakosa, Ardani Hasan, Harris Hayati, Yati Sri Hendrawati Hendrawati Heny Martini Heny Martini Hergaf, Indah Widyasari Hidayanti, Puji Astuti Nur Idris Idham Ikeningrum, Dyah Ayu Imelda Krisnasari Indhiarti, Tantri Refa Indra Prasetya Indra Prasetya Indra Prasetya Indriani, Anin Indriyani, Damayanti Irsad Andi Arso, Irsad Andi Iskandar Iskandar Jannah, Riska Raudhatul Kartika, Annisa Wuri Krevani, Citra Kiki Kurnianingsih, Novi Lestari, Defyna Dwi Liemena Harold Adrian Machfud, Savinka Salsabiela Iriana Maimun Zulhaidah Arthamin, Maimun Zulhaidah Makes, Indira Kalyana Martini, Heny Mayangsari, Veny Mifetika Lukitasari Mohammad Ryan Ramadhan Mohammad Saifur Rohman Mohammad Saifur Rohman Monika Sitio Muchammad Dzikrul Haq Karimullah Muhammad Abusari Muhammad Firdaus Muhammad Munawar Muhammad Ridwan Muhammad Rizki Fadlan Muhammad Rizki Fadlan Muhammad Rizki Rizki Fadlan Ni Putu Frida Baskarani Novi Kurnianingsih Novi Kurniningsih Oktafin Srywati Pamuna Olivia Handayani Pawik Supriadi Pratiwi, Irma Kamelia Puji Astuti Nur Hidayanti Putri, Valerina Yogibuana Swastika Qhabibi, Faqrizal Ria Rahimah, Anna Fuji Ratna Pancasari Raynaldo, Abdul Halim Rita Hamdani Rizal, Ardian RWM Kaligis Saskia Dyah Handari Sasmojo Widito Sasmojo Widito Satrijo, Budi Satwikajati, Sawitri sawitri satwikajati Seprian Widasmara Setyasih Anjarwani Setyowati, Danti Utami Susilowati, Eliana Swastika Putri, Valerinna Yogibuana Swastikaputri, Valerina Yogibuana Syaoqi, Muhammad Tarsidin, Najmi Fauzan Titin Andri Wihastuti Tonny Adriyanto Vori, Ira Widiani, Luh Widito, Sasmojo Wira Kimahesa Anggoro Wulandari, Ayu Pramitha Yasmine Fitrina Siregar Yoga Waranugraha Yogibuana, Valerinna Yudha, Tria Yusuf Arifin Zulhaidah A, Maimun