急性心肌梗死患者急诊经皮冠状动脉介入治疗后行早期心脏康复的安全性研究

Safety of Early Cardiac Rehabilitation after PCI in Patients with Acute Myocardial Infarction

目的 探讨急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)后行早期心脏康复的安全性。方法 在首都医科大学附属北京友谊医院心血管中心CBD-Bank数据库选取2017年5月至2019年12月住院的AMI患者1 364例,根据纳入与排除标准最终纳入379例行急诊PCI的AMI患者。根据患者是否接受早期心脏康复将其分为心脏康复组(接受早期心脏康复患者,n=79)和对照组(未接受早期心脏康复患者,n=300)。对两组患者基线资料进行1∶1倾向性评分匹配。比较两组患者住院期间主要不良心血管事件(MACE)发生率及随访1年全因死亡率、心源性死亡率、因急性冠脉综合征(ACS)再住院率。结果 匹配后,两组心源性死亡率及靶血管重建、恶性心律失常发生率比较,差异无统计学意义(P>0.05)。匹配后,两组随访1年全因死亡率、心源性死亡率比较,差异无统计学意义(P>0.05);心脏康复组随访1年因ACS再住院率低于对照组(P<0.05)。结论 AMI患者急诊PCI后开展早期心脏康复相对安全,且早期心脏康复可有效降低AMI患者因ACS再住院率。

Objective To investigate the safety of early cardiac rehabilitation after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods In the CBD-Bank database of Cardiovascular Center of Capital Medical University Affiliated Beijing Friendship Hospital,1364 AMI patients hospitalized from May 2017 to December 2019 were selected.According to the inclusion and exclusion criteria,379 AMI patients undergoing emergency PCI were finally included.According to whether the patients received early cardiac rehabilitation,they were divided into cardiac rehabilitation group(patients receiving early cardiac rehabilitation,n=79)and control group(patients without receiving early cardiac rehabilitation,n=300).The baseline data of the two groups were matched by 1∶1 propensity score.The incidence of major adverse cardiovascular events(MACE)during hospitalization and all-cause mortality,cardiogenic mortality and rehospitalization rate due to acute coronary syndrome(ACS)during 1-year follow-up were compared between the two groups.Results After matching,there was no significant difference in cardiogenic mortality,incidence of target vessel remodeling and malignant arrhythmias between the two groups(P>0.05).After matching,there was no significant difference in all-cause mortality and cardiogenic mortality during 1-year follow-up between the two groups(P>0.05);the rehospitalization rate due to ACS during 1-year follow-up in the cardiac rehabilitation group was lower than that in the control group(P<0.05).Conclusion It is relatively safe for AMI patients to carry out early cardiac rehabilitation after emergency PCI,and early cardiac rehabilitation can effectively reduce the rehospitalization rate due to ACS of AMI patients.