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

李馨妍; 王耿; 张权宇; 李根; 谢海方; 肖瑶; 慕艳燕

doi:10.13201/j.issn.1001-1439.2023.11.011

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

- 北部战区总医院心内科(沈阳，110016)

详细信息

通讯作者: 王耿，E-mail：wanggeng69@163.com

中图分类号: R542.2

收稿日期: 2023-07-23

刊出日期: 2023-11-13

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

- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, 110016, China

More Information

Corresponding author: WANG Geng, E-mail: wanggeng69@163.com

Received Date: 23 July 2023

Publish Date: 13 November 2023

摘要

摘要: 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。
- 心脏康复 /
- ST段抬高型心肌梗死 /
- 经皮冠状动脉介入 /
- 缺血事件
Abstract: 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.
- cardiac rehabilitation /
- ST-segment elevation myocardial infarction /
- percutaneous coronary intervention /
- ischemic events

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图 1 Kaplan-Meier曲线

Figure 1. Kaplan-Meier curves

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表 1 匹配前后基线资料比较

Table 1. Baseline data before and after propensity score matching 例(%), X±S

项目	匹配前				匹配后
项目	非康复组 (4 353例)	康复组 (590)	t/χ²	P	非康复组 (1 166例)	康复组 (583例)	t/χ²	P
年龄/岁	60.09±11.65	53.42±10.46	14.331 6	< .000 1	53.63±11.17	53.42±10.47	0.372 3	0.709 7
男性	3 414(78.43)	528(89.49)	39.374 5	< .000 1	1 037(88.94)	522(89.54)	0.144 7	0.703 7
高血压病	2 297(52.89)	300(51.02)	0.725 9	0.394 2	611(52.40)	297(50.94)	0.331 0	0.565 1
糖尿病	1 143(26.35)	141(23.94)	1.562 7	0.211 3	282(24.19)	141(24.19)	0	1
既往心肌梗死	313(7.22)	32(5.43)	2.538 3	0.111 1	57(4.89)	31(5.32)	0.149 6	0.698 9
既往卒中	662(15.26)	44(7.51)	25.277 0	< .000 1	86(7.38)	44(7.55)	0.016 6	0.897 4
既往PCI	347(7.99)	39(6.62)	1.343 1	0.246 5	68(5.83)	38(6.52)	0.321 4	0.570 8
外周血管疾病	20(0.46)	3(0.51)	0.026 5	0.870 6	7(0.60)	3(0.51)	0.050 3	0.822 6
吸烟情况			24.172 4	< .000 1			0.298 4	0.861 4
不吸烟	1 469(33.92)	144(24.49)			298(25.56)	142(24.36)
当前吸烟	2 481(57.28)	398(67.69)			779(66.81)	396(67.92)
既往吸烟	381(8.80)	46(7.82)			89(7.63)	45(7.72)

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表 2 匹配前后PCI相关资料比较

Table 2. PCI-related data before and after propensity score matching 例(%), X±S

项目	匹配前				匹配后
项目	非康复组 (4 353例)	康复组 (590)	t/χ²	P	非康复组 (1 166例)	康复组 (583例)	t/χ²	P
桡动脉入路	3 933(90.35)	581(98.47)	43.256 9	< .000 1	1 153(98.89)	574(98.46)	0.575 4	0.448 1
靶血管位置
左主干	103(2.37)	15(2.54)	0.069 2	0.792 5	27(2.32)	15(2.57)	0.109 8	0.740 4
左前降支	2 261(51.94)	316(53.56)	0.545 2	0.460 3	625(53.60)	313(53.69)	0.001 1	0.973 0
左回旋支	629(14.45)	94(15.93)	0.914 3	0.339 0	191(16.38)	92(15.78)	0.103 3	0.747 9
右冠脉	1 762(40.48)	257(43.56)	2.041 9	0.153 0	498(42.71)	254(43.57)	0.116 6	0.732 7
支架个数	1.30±0.80	1.44±0.77	-4.178 9	< .000 1	1.41±0.82	1.44±0.77	-0.821 3	0.411 6
支架总长度/mm	38.73±21.92	41.61±23.13	-2.888 0	0.003 9	41.21±23.89	41.67±23.19	-0.369 1	0.712 1
平均支架直径/mm	3.06±0.68	3.10±0.39	-1.710 1	0.087 5	3.13±1.12	3.10±0.39	0.972 5	0.331 0

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表 3 匹配前后出院用药

Table 3. Discharge medication before and after propensity score matching 例(%)

项目	匹配前				匹配后
项目	非康复组 (4 353例)	康复组 (590)	t/χ²	P	非康复组 (1 166例)	康复组 (583例)	t/χ²	P
阿司匹林	4 101(94.21)	582(98.64)	20.491 1	< .000 1	1 157(99.23)	575(98.63)	1.455 3	0.227 7
P2Y12受体拮抗剂			1.377 4	0.240 5			0.306 1	0.580 1
氯吡格雷	2 617(61.66)	349(59.15)			710(60.89)	347(59.52)
替格瑞洛	1 627(38.34)	241(40.85)			456(39.11)	236(40.48)
他汀	3 840(88.22)	551(93.39)	14.025 5	0.000 2	1105(94.77)	544(93.31)	1.532 6	0.215 7
ACEI/ARB	2 864(65.79)	456(77.29)	31.127 9	< .000 1	905(77.62)	451(77.36)	0.014 8	0.903 3
β受体阻滞剂	2 868(65.89)	403(68.31)	1.358 8	0.243 7	801(68.70)	399(68.44)	0.011 9	0.913 0

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表 4 匹配前后缺血事件、全因死亡复合终点比较

Table 4. Ischemic events and all-cause death before and after propensity score matching 例(%)

项目	匹配前				匹配后
项目	非康复组 (4 353例)	康复组 (590)	t/χ²	P	非康复组 (1 166例)	康复组 (583例)	t/χ²	P
缺血事件	231(5.31)	6(1.02)	19.5473	< 0.000 1	29(2.49)	6(1.03)	4.212 9	0.040 1
心源性死亡	161(3.70)	2(0.34)	18.3906	< 0.000 1	19(1.63)	2(0.34)	5.422 2	0.019 9
心肌梗死	44(1.01)	2(0.34)	2.5436	0.110 7	7(0.60)	2(0.34)	0.502 6	0.478 4
缺血性卒中	26(0.60)	2(0.34)	0.6155	0.432 7	3(0.26)	2(0.34)	0.100 3	0.751 5
全因死亡	189(4.34)	3(0.51)	20.4505	< .000 1	21(1.80)	3(0.51)	4.752 7	0.029 3

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