心脏康复对老年急性冠状动脉综合征人群影响

Effect of cardiac rehabilitation on elderly patients with acute coronary syndrome

目的探讨心脏康复对老年急性冠状动脉综合征(ACS)患者临床预后的影响。方法回顾性分析自2016年3月至2019年3月于北部战区总医院心血管内科接受经皮冠状动脉介入治疗(PCI)的年龄≥65岁的7961例ACS患者的临床资料。根据患者是否接受心脏康复治疗将其分为接受心脏康复治疗组(CR组,n=1130)与未接受心脏康复治疗组(NCR组,n=6791)。由于两组样本量相差较大,故采用2∶1比例进行倾向性匹配。收集所有患者的临床资料,包括基线资料、手术相关资料及用药相关资料。随访1年,主要终点为患者出院后12个月的缺血事件,定义为心源性死亡、心肌梗死、缺血性卒中的复合终点。结果倾向性匹配前,CR组的年龄、支架总长度,以及既往心肌梗死、既往PCI、既往脑卒中病史、外周血管疾病、靶血管位置为右冠状动脉的患者比例均低于NCR组;男性、既往吸烟、不稳定性心绞痛、采用桡动脉入路及靶血管位置为左冠状动脉前降支、应用阿司匹林、替格瑞洛、他汀类、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂类药物的患者比例,以及平均支架直径均高于NCR组,差异均有统计学意义(P<0.05)。倾向性匹配后,两组患者的基线特征资料、手术相关资料及用药情况比较,差异均无统计学意义(P>0.05)。随访12个月,无论倾向性匹配前后,CR组患者的缺血性事件、心源性死亡及全因死亡发生率均低于NCR组,差异均有统计学意义(P<0.05);而两组心肌梗死、缺血性脑卒中的发生率比较,差异均无统计学意义(P>0.05)。结论心脏康复改善了老年ACS人群缺血性事件、心源性死亡、全因死亡等临床预后。

Objective To investigate the effect of cardiac rehabilitation on the clinical prognosis of elderly patients with acute coronary syndrome(ACS).Methods The clinical data of 7961 ACS patients aged≥65 years who underwent percutaneous coronary intervention(PCI)in the Department of Cardiovascular Medicine,General Hospital of Northern Theater Command from March 2016 to March 2019 were retrospectively analyzed.The patients were divided into two groups according to whether they received cardiac rehabilitation therapy(CR group,n=1130)and no cardiac rehabilitation therapy(NCR group,n=6791).Due to the large difference in sample size between the two groups,a 2:1 ratio was used for propensity matching.Clinical data of all patients were collected,including baseline data,surgery-related data and medication related data.The primary end point was an ischemic event 12 months after discharge,which was defined as the composite end point of cardiac death,myocardial infarction,and ischemic stroke.Results Before propensity matching,age,total stent length,previous myocardial infarction,previous PCI,previous stroke history,peripheral vascular disease,and the proportion of patients with right coronary artery target location in CR group were lower than those in NCR group,and the proportion of male,previous smoking,unstable angina pectoris,radial artery approach and target vessel location of left anterior descending coronary artery,aspirin,ticagrelor,statins,angiotensin-converting enzyme inhibitors,angiotensin converting enzyme inhibitors/angiotensin receptor antagonists and the average stent diameter were higher than those in the NCR group(P<0.05).After propensity matching,there were no significant differences in baseline characteristics,surgery-related data and medication between the two groups(P>0.05).After 12 months of follow-up,the incidence rates of ischemic events,cardiac death and all-cause death in CR group were lower than those in NCR group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of myocardial infarction and ischemic stroke between the two groups(P>0.05).Conclusion Cardiac rehabilitation improves the clinical prognosis of ischemic events,cardiac death,and all-cause death in elderly ACS patients.