新型冠状病毒肺炎流行前与流行期间ACS患者PCI术后心肺运动试验特征的变化

Exploring the characteristics changes of cardiopulmonary exercise testing in patients with acute coronary syndrome after PCI before and during the COVID-19 pandemic

目的探究新型冠状病毒肺炎(COVID-19)流行前及流行期间, 接受经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者心肺运动试验特征的变化。方法本研究为横断面研究, 纳入2018年7月至2023年2月在解放军北部战区总医院接受PCI治疗的ACS患者。根据COVID-19流行时间, 以2020年1月为界, 将患者分为COVID-19流行前组和流行期间组。收集2组患者的临床资料, 比较2组患者术后心肺运动试验测试结果, 包括峰值摄氧量、峰值代谢当量等指标, 并采用Weber心功能分级评估心脏功能。同时, 采用7个症状条目的广泛性焦虑量表(GAD-7)和9项患者健康问卷(PHQ-9)分别评估患者的焦虑和抑郁状态。采用多因素logistic回归分析PCI术后心肺功能的影响因素。结果共纳入4 310例PCI术后的ACS患者, 年龄(58.7±9.1)岁, 男性3 464例(80.37%), COVID-19流行前组1 698例, COVID-19流行期间组2 612例。COVID-19流行期间组的心肺运动试验主要指标峰值公斤摄氧量(15.04±3.93)ml·min^(-1)·kg^(-1)低于流行前组(15.52±3.68)ml·min^(-1)·kg^(-1), 差异有统计学意义(P<0.001)。多因素logistic回归分析显示, 高龄、女性、高体重指数、超敏C反应蛋白升高、高密度脂蛋白胆固醇降低、吸烟史、心肌梗死史、较重的ACS分型、轻度和中度的抑郁程度与心肺功能不良结局相关(P<0.05)。结论 COVID-19流行对PCI术后ACS患者的心肺功能产生了不利影响。

ObjectiveTo investigate the changes in cardiopulmonary exercise testing(CPET)characteristics before and after the outbreak of COVID-19 in patients with acute coronary syndrome(ACS)who underwent percutaneous coronary intervention(PCI).MethodsThis is a cross-sectional study that included ACS patients who underwent PCI at the General Hospital of the Northern Theater Command from July 2018 to February 2023.Based on the timeline of the COVID-19 pandemic,patients were divided into two groups:the pre-pandemic group and the during-pandemic group,with January 2020 as the dividing line.Clinical data were collected from both groups,and a comparative analysis was performed on their postoperative CPET outcomes,including peak oxygen uptake(peak VO 2),peak metabolic equivalents(peak MET),and other indicators.Weber′s classification was used to assess cardiac function.In addition,the 7-tiem generalized anxiety disorder scale(GAD-7)and the patient health questionnaire-9(PHQ-9)were used to assess the patients′psychological anxiety and depression states,respectively.Multivariate logistic regression was used to analyze the influencing factors of CPET after PCI.ResultsA total of 4310 post-PCI ACS patients were included,with an average age of(58.7±9.1)years,and 3464(80.37%)were male.There were 1698 patients in the pre-pandemic group and 2612 patients in the during-pandemic group.The main indicator of the CPET,peak VO 2(15.04±3.93)ml·min^(-1)·kg^(-1) in the during-pandemic group,was lower than that in the pre-pandemic group(15.52±3.68)ml·min^(-1)·kg^(-1),and the difference was statistically significant(P<0.001).Multivariate logistic regression analysis showed that advanced age,female gender,high body mass index,elevated high-sensitivity C-reactive protein,reduced high-density lipoprotein cholesterol,smoking history,history of myocardial infarction,more severe ACS classification,and mild to moderate degree of depression were related to poor cardiopulmonary outcomes(P<0.05).ConclusionThe COVID-19 pandemic had a negative impact on the cardiopulmonary outcomes of ACS patients after PCI.Reduced physical activity,and increased psychological stress should be given consideration and attention regarding their impact on patients′cardiopulmonary function.