基于CPET指导的心脏康复对接受PCI治疗的ST段抬高型心肌梗死患者的疗效及安全性研究

Efficacy and safety of cardiac rehabilitation guided by CPET in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention

目的:探讨心脏康复治疗对接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)患者的疗效及安全性。方法:回顾性分析2016年3月—2019年3月于北部战区总医院心内科接受PCI治疗的STEMI患者4 943例,以患者住院期是否接受心脏康复治疗分为康复组(590例)及非康复组(4 353例)。进行倾向评分分析并选择两个匹配良好的亚组[康复组(583例),非康复组(1 166例)],以评估12个月的临床结果。主要终点为患者出院后12个月的缺血事件和全因死亡,缺血事件为心源性死亡、心肌梗死、缺血性卒中的复合终点。结果:由于两组匹配前样本量相差较大,故采用2:1比例进行倾向性匹配,匹配后两组在缺血事件(1.03%vs 2.49%,P=0.040 1),包括心源性死亡(0.34%vs 1.63%,P=0.0199)、心肌梗死(0.34%vs 0.60%,P=0.478 4)和缺血性卒中(0.34%vs 0.26%,P=0.751 5),以及全因死亡(0.51%vs 1.08%,P=0.029 3)方面相比较均差异有统计学意义。结论:12个月随访结果显示,接受心脏康复运动可降低STEMI患者心源性死亡及全因死亡风险,改善预后。

Objective:To investigate the efficacy and safety of cardiac rehabilitation in patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing percutaneous coronary intervention(PCI).Methods:A total of 4 943 STEMI patients who underwent PCI in the Department of Cardiology,General Hospital of Northern Theater from March 2016 to March 2019 were retrospectively analyzed,and divided into the rehabilitation group(n=590) and the non-rehabilitation group(n=4 353) according to whether they received cardiac rehabilitation during hospitalization.Propensity score analysis was performed and two well-matched subgroups(rehabilitation group,n=583,and non-rehabilitation group,n=1 166) were selected to assess clinical outcomes at 12 months.The primary endpoints were ischemic events 12 months after discharge,defined as the combined endpoints of cardiac death,myocardial infarction,and ischemic stroke.Results:To address the substantial difference in sample size before matching,a 2∶1 ratio was applied for propensity matching.After matching,there were statistical differences between the two groups in ischemic events(1.03% vs 2.49%,P=0.040 1),including cardiac death(0.34% vs 1.63%,P=0.019 9),myocardial infarction(0.34% vs 0.60%,P=0.478 4),and ischemic stroke(0.34% vs 0.26%,P=0.751 5),as well as all-cause death(0.51% vs 1.08%,P=0.029 3).Conclusion:After 12 months of follow-up,cardiac rehabilitation exercise can reduce the risk of cardiac death and all-cause death in STEMI patients,and improve the prognosis.