行心肺康复治疗急性冠状动脉综合征患者经皮冠状动脉介入治疗术后室壁瘤临床预后分析

Clinical analysis of prognosis of ventricular aneurysm after percutaneous coronary intervention in patients with acute coronary syndrome treated with cardiopulmonary rehabilitation

目的探讨心肺运动试验(CPET)指导下的心脏康复治疗对急性冠状动脉综合征(ACS)合并室壁瘤患者行经皮冠状动脉介入治疗(PCI)术后1年的临床预后的影响。方法将自2016年2月至2018年9月北部战区总医院收治的ACS合并室壁瘤行PCI术且术后给予CPET的50例患者设为B组,将术后未给予CPET的80例患者设为A组。所有纳入患者在院期间PCI术后均恢复完全血运重建。所有完成CPET的患者出院后均按照运动处方于院外进行规律的心脏康复治疗。记录并比较入院后患者的一般资料、生化指标、心脏超声指标、临床用药情况、冠状动脉病变情况,以及随访期间临床终点事件的发生情况。结果两组患者的一般资料、各项生化指标、冠状动脉病变情况、心脏超声指标及临床用药情况比较,差异无统计学意义(P>0.05)。B组患者PCI术后1年主要不良心脑血管事件(MACCE)、心绞痛复发及血运重建发生率低于A组,差异有统计学意义(P<0.05);两组患者心肌梗死、脑卒中、心力衰竭发生率比较,差异无统计学意义(P>0.05)。多因素Logistic分析结果表明,康复治疗是PCI术后发生MACCE的独立保护性因素(风险比:0.270,95%可信区间:0.089~0.820,P<0.05)。Kaplan-Meier分析显示,B组MACCE的发生率均明显低于A组,差异有统计学意义(P<0.05)。结论CPET是一种安全的心脏康复指导手段,可以降低ACS合并室壁瘤患者PCI术后1年内MACCE的发生率。

Objective To investigate the effect of cardiopulmonary exercise testing(CPET)on the clinical prognosis of patients with acute coronary syndrome(ACS)complicated with ventricular aneurysm 1 year after percutaneous coronary intervention(PCI).Methods A retrospective study was performed on 50 cases of patients with CPET after PCI(Group B)from February 2016 to September 2018,the other 80 cases of patients without CPET were in Group A.All included patients recovered complete revascularization after PCI in the hospital.After discharge,all patients with ventricular aneurysm who completed CPET underwent regular cardiac rehabilitation treatment outside the hospital according to the exercise prescription.General data,biochemical indicators,cardiac ultrasound indicators,clinical medication,coronary artery lesions,and clinical end-point events were recorded and compared.Results There was no significant difference in the general data between the two groups(P>0.05).There was no statistically significant difference between the two groups in various biochemical indicators and coronary artery lesions(P>0.05).There was no statistically significant difference between the two groups in cardiac ultrasound indicators and medication use(P>0.05).The incidence of MACCE,angina pectoris recurrence and revascularization in Group B 1 year after PCI was lower than that in Group A,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of myocardial infarction,stroke and heart failure between the two groups(P>0.05).Multivariate Logistic analysis showed that rehabilitation was an independent protective factor for MACCE after PCI(risk ratio:0.270,95%CI:0.089-0.820,P<0.05).Kaplan-Meier analysis showed that the incidence of MACCE in Group B was significantly lower than that in Group A(P<0.05).Conclusion CPET is a safe cardiac rehabilitation guidance method,which can reduce the incidence of MACCE in ACS patients with ventricular aneurysm within 1 year after PCI.