In the PAMI-2 (Primary Angioplasty in Myocardial Infarction) trial, patients were encouraged to return to work 2 weeks after primary PCI for STEMI, and no adverse events were reported.862 In the RITA (Randomized Intervention Treatment of Angina) trial, revascularization with PCI led to earlier return to work compared with CABG, and subsequent employment rates were associated with relief of angina.105 Many practitioners use graded exercise treadmill testing to determine the safety of activity and return to work by measuring the metabolic equivalent of task (MET) level achieved and comparing that level to energy levels required to perform different activities.863 6.4.3. Cardiac Rehabilitation: Recommendation Class I 1. Medically supervised exercise programs (cardiac rehabilitation) should be recommended to patients after PCI, particularly for moderate- to high-risk patients for whom supervised exercise training is warranted.796 804 (Level of Evidence: A) Participation in cardiac rehabilitation is associated with sig- nificant reductions in all-cause mortality (OR: 0.80, 95% CI: 0.68 to 0.93) and cardiac mortality.796,797 Reports from community-based surveys, which in general enroll older and higher-risk patients than clinical trials, have confirmed that participation in comprehensive rehabilitation is indepen- dently associated with a reduction in recurrent MI and reduced mortality.799 Cardiac rehabilitation is also associated with improvements in exercise tolerance, cardiac symptoms, lipid levels, cigarette smoking cessation rates (in conjunction with a smoking cessation program), stress levels, improved medical regimen compliance, and improved psychosocial well- being.800 Cardiac rehabilitation is cost-effective as well.864 Phy- sician referral may be the most powerful predictor of patient participation in a cardiac rehabilitation program.865 6.5. Secondary Prevention The treatment of the patient does not end with PCI; secondary prevention measures are a critical component of patient management. 