急性心肌梗死患者经皮冠状动脉介入治疗后急性期心脏康复参与现状及其影响因素研究

Current Status of Cardiac Rehabilitation Participation during the Acute Phase in Patients with Acute Myocardial Infarction after PCI and Its Influencing Factors

目的 分析急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后急性期心脏康复参与现状及其影响因素。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月行PCI的AMI患者1 365例,根据是否参与急性期心脏康复将其分为康复组(n=409)和非康复组(n=956)。收集两组患者临床资料,AMI患者PCI后参与急性期心脏康复的影响因素分析采用单因素、多因素Logistic回归分析。结果 AMI患者PCI后急性期心脏康复参与率为29.96%(409/1 365)。随着年龄增长,AMI患者PCI后急性期心脏康复参与率呈下降趋势(P<0.05)。AMI患者PCI后即刻至心脏康复开始时间平均为3.5 d。多因素Logistic回归分析结果显示,腹型肥胖〔OR=1.508,95%CI(1.163,1.956)〕、手术类型〔OR=1.804,95%CI(1.398,2.328)〕、冠心病史〔OR=0.737,95%CI(0.548,0.991)〕、心律失常史〔OR=0.540,95%CI(0.332,0.878)〕、脑卒中史〔OR=0.655,95%CI(0.450,0.954)〕、冠心病家族史〔OR=1.325,95%CI(1.020,1.721)〕、左心室射血分数(LVEF)降低〔OR=0.692,95%CI(0.489,0.979)〕是AMI患者PCI后参与急性期心脏康复的独立影响因素(P<0.05)。结论 AMI患者PCI后急性期心脏康复参与率为29.96%,且随着年龄增长,其急性期心脏康复参与率呈下降趋势,其中腹型肥胖、行急诊PCI及无LVEF降低、冠心病史、心律失常史、脑卒中史、冠心病家族史的AMI患者PCI后参与急性期心脏康复的概率更高。

Objective To analyze the current status of cardiac rehabilitation participation during the acute phase in patients with acute myocardial infarction after percutaneous coronary intervention (PCI) and its influencing factors.Methods In the CBD-Bank database of Department of Rehabilitation Medicine,Capital Medical University Affiliated Beijing Friendship Hospital,1 365 AMI patients who underwent PCI from May 2017 to December 2019 were selected and divided into rehabilitation group (n=409) and non rehabilitation group (n=956) according to whether they participated cardiac rehabilitation during acute phase.The clinical data of the two groups were collected.The influencing factors of AMI patients participating cardiac rehabilitation during acute phase after PCI were analyzed by univariate and multivariate Logistic regression analysis.Results The participation rate of cardiac rehabilitation during acute phase in AMI patients after PCI was 29.96% (409/1 365).With the increase of age,the participation rate of cardiac rehabilitation during acute phase in AMI patients after PCI decreased (P < 0.05).The average time from PCI to cardiac rehabilitation in AMI patients was 3.5 days.Multivariate Logistic regression analysis showed that abdominal obesity[OR=1.508,95%CI (1.163,1.956)],operation type[OR=1.804,95%CI (1.398,2.328)],history of coronary heart disease[OR=0.737,95%CI (0.548,0.991)],history of arrhythmia[OR=0.540,95%CI (0.332,0.878)],history of stroke[OR=0.655,95%CI (0.450,0.954)],family history of coronary heart disease[OR=1.325,95%CI (1.020,1.721)]and decrease of left ventricular ejection fraction (LVEF)[OR=0.692,95%CI (0.489,0.979)]were independent influencing factors for cardiac rehabilitation during acute phase in AMI patients after PCI (P < 0.05).Conclusion The participation rate of cardiac rehabilitation during acute phase in AMI patients after PCI was 29.96%.With age increasing,the participation rate of cardiac rehabilitation during acute phase showed a downward trend.Among them,AMI patients with abdominal obesity,emergency PCI,without decreased LVEF and no history of coronary heart disease,arrhythmia,stroke,coronary heart disease have a higher probability of participating cardiac rehabilitation during acute phase after PCI.