Piestrzeniewicz Katarzyna, Navarro-Kuczborska Natalia, Bolińska Halina, Jegier Anna, Maciejewski Marek
Klinika Kardiologii Instytutu Kardiologii UM w Łodzi.
Pol Arch Med Wewn. 2004 Mar;111(3):309-17.
The aim of our study was to evaluate the impact of comprehensive 3-phases cardiac rehabilitation in patients aged up to 55 years after acute myocardial infarction treated with primary coronary intervention (PCI) of the infarction related artery on the cardiovascular status, modification of coronary risk factors, psychological and physical status and exercise tolerance.
Out of 106 consecutive patients aged up to 55 years with acute myocardial infarction (AMI) with ST-segment elevation, treated with primary coronary intervention (PCI) of the infarction related artery 71 patients entered the study and were randomized either to the Study Group (GB) or to the Control Group (GK). 31 patients of GB underwent 3-phases cardiac rehabilitation program and 40 patients of GK did not participate in phase III of the program. At phase I of the rehabilitation and 6 months after myocardial infarction physical examination, echocardiography and treadmill exercise test were performed.
At 6-months follow-up chest pain and symptoms of heart failure were significantly less common (p < 0.001) and a tendency for fewer new cardiac events and re-PCI was noted in GB. Self-evaluated, significantly greater improvement in the emotional and physical status as well as in physical activity (p < 0.001) was achieved in GB. In GB better exercise tolerance on treadmill exercise test, greater improvement in left ventricular ejection fraction (p < 0.05) and contractile index (p < 0.05) on echocardiography were observed. The effects of the secondary prevention in terms of smoking cessation and obesity were not satisfactory in both groups.
3-phases comprehensive cardiac rehabilitation in patients with AMI treated with PCI of the infarction related artery improves recovery at 6-month follow-up. It has a favorable impact on the anginal and heart failure symptoms, cardiac risk factors (especially physical activity, restrictive diet), psychological and physical status. It contributes towards maintaining a further event-free period. It improves selected cardiovascular parameters such as exercise tolerance, segmental and global left ventricular function.
我们研究的目的是评估在年龄不超过55岁、因急性心肌梗死接受梗死相关动脉的初级冠状动脉介入治疗（PCI）后的患者中，进行全面的三阶段心脏康复对心血管状况、冠状动脉危险因素的改变、心理和身体状况以及运动耐量的影响。
在106例年龄不超过55岁、患有ST段抬高型急性心肌梗死（AMI）且接受梗死相关动脉初级冠状动脉介入治疗（PCI）的连续患者中，71例患者进入研究并被随机分为研究组（GB）或对照组（GK）。GB组的31例患者接受了三阶段心脏康复计划，GK组的40例患者未参与该计划的第三阶段。在康复的第一阶段以及心肌梗死后6个月进行体格检查、超声心动图和跑步机运动试验。
在6个月的随访中，GB组胸痛和心力衰竭症状明显较少见（p<0.001），且新的心脏事件和再次PCI的发生率有减少的趋势。GB组在自我评估中，情绪和身体状况以及身体活动方面有显著更大的改善（p<0.001）。在GB组中，观察到跑步机运动试验中有更好的运动耐量，超声心动图上左心室射血分数（p<\(0.05\)）和收缩指数（p<\(0.05\)）有更大的改善。两组在戒烟和肥胖的二级预防方面效果均不令人满意。
在接受梗死相关动脉PCI治疗的AMI患者中进行三阶段全面心脏康复可改善6个月随访时的恢复情况。它对心绞痛和心力衰竭症状、心脏危险因素（尤其是身体活动、严格饮食）、心理和身体状况有有利影响。它有助于维持进一步的无事件期。它改善了选定的心血管参数，如运动耐量、节段性和整体左心室功能。
