心脏康复对于心肌梗死后再发急性冠状动脉综合征患者接受经皮冠状动脉介入治疗远期预后影响分析

Effect of cardiac rehabilitation on long-term prognosis of patients with acute coronary syndrome after myocardial infarction undergoing percutaneous coronary intervention

目的探讨心脏康复对心肌梗死(MI)后再发急性冠状动脉综合征(ACS)患者接受经皮冠状动脉介入治疗(PCI)远期预后的影响。方法选取自2016年3月至2019年3月北部战区总医院心血管内科接受PCI治疗的4000例ACS患者为研究对象。根据住院期间是否接受心脏康复治疗将其分为未康复组(n=3128)与康复组(n=872)。采用倾向性评分匹配法校正组间差异。记录并比较两组患者的基线资料、冠状动脉特点及介入情况、出院用药情况、不良事件发生情况。采用Kaplan-Meier生存分析绘制缺血事件与全因死亡结局风险曲线。结果倾向性评分匹配前,康复组患者桡动脉入路比例高于未康复组,靶血管位置为左主干比例低于未康复组,差异均有统计学意义(P<0.05);倾向性评分匹配后,两组患者冠状动脉特点及介入情况比较,差异均无统计学意义(P>0.05)。倾向性评分匹配前,康复组患者出院服用阿司匹林、替格瑞洛比例高于未康复组,服用氯吡格雷比例低于未康复组,差异均有统计学意义(P<0.05);倾向性评分匹配后,两组患者出院用药情况比较,差异均无统计学意义(P>0.05)。倾向性评分匹配前,未康复组患者心源性死亡、MI、缺血事件、全因死亡发生率均显著高于康复组,差异均有统计学意义(P<0.05);倾向性评分匹配后,未康复组患者心源性死亡、MI、缺血事件、全因死亡发生率仍显著高于康复组,差异均有统计学意义(P<0.05)。Kaplan-Meier生存曲线显示,倾向性评分匹配后,未康复组患者缺血事件及全因死亡发生率均显著高于康复组,差异均有统计学意义(P<0.05)。结论心脏康复治疗可降低接受PCI的MI后再发ACS患者的缺血事件及全因死亡发生风险,改善远期临床预后。

Objective To investigate the effect of cardiac rehabilitation on the long-term prognosis of patients with acute coronary syndrome(ACS)following myocardial infarction(MI)after percutaneous coronary intervention(PCI).Methods From March 2016 to March 2019,4000 ACS patients who received PCI in the department of cardiology of General Hospital of Northern Theater Command were selected as the study subjects.According to whether they had received cardiac rehabilitation during hospitalization,they were divided into non-recovery group(n=3128)and recovery group(n=872).Propensity score matching was used to correct differences between groups.Baseline data,coronary artery characteristics and intervention,discharge medication,and adverse events of 2 groups were recorded and compared.Kaplan-meier survival analysis was used to plot the risk curves of ischemic events and all-cause death outcomes.Results Before propensity score matching,the proportion of radial artery approach in the rehabilitation group was higher than that in the non-rehabilitation group,and the proportion of target vessel location in the left main artery was lower than that in the non-rehabilitation group,with statistical significance(P<0.05).After propensity score matching,there was no significant difference in coronary artery characteristics and intervention between 2 groups(P>0.05).Before propensity score matching,the proportion of patients in the rehabilitation group taking aspirin and ticagrelor was higher than that in the non-rehabilitation group,and the proportion of patients taking clopidogrel was lower than that in the non-rehabilitation group,with statistical significance(P<0.05).After propensity score matching,there was no statistical significance in discharge medication status between 2 groups(P>0.05).Before propensity score matching,the incidence of cardiogenic death,MI,ischemic events and all-cause death in the non-rehabilitation group was significantly higher than that in the rehabilitation group,with statistical significance(P<0.05).After propensity score matching,the incidence of cardiogenic death,MI,ischemic events and all-cause death in the non-rehabilitation group was still significantly higher than that in the rehabilitation group,with statistical significance(P<0.05).Kaplan-meier curve showed that after matching,the incidence of ischemic events and all-cause death in the non-recovered group was significantly higher than that in the recovered group,with statistical significance(P<0.05).Conclusion Cardiac rehabilitation can reduce the risk of ischemic events and all-cause death in ACS patients following MI after PCI,and improve the long-term clinical prognosis.