Wolf R, Habel F, Heiermann M, Jäkel R, Sinn R
Herz- und Gefässzentrum Bevensen, Abteilung Kardiologie/Rehabilitation, Römstedter Strasse 25, 29549 Bad Bevensen, Germany.
Z Kardiol. 2005 Apr;94(4):265-73. doi: 10.1007/s00392-005-0209-2.
The job related reintegration of patients with coronary artery disease (CAD) is a central part of cardiac rehabilitation. However, specific occupational demands like jobs with heavy physical exertion (> 6 METs) could increase the cardiovascular risk because the relative risk for acute myocardial infarction (MI) and cardiac death is temporarily elevated after vigorous exertion ("hazard period"). Thus, in 2001 any male patient with proven CAD who performed a job with heavy exertion until the occurrence of an index event (MI/ACS, any interventional or surgical revascularization measure) received a questionnaire after an average of 20 months. Complete data were available in 108 from 119 included patients (90.8%), aged 51.8+/-7.8 years. Ejection fraction was 61.5+/-13.1% and the functional capacity at the time of hospital discharge averaged 130.1+/-31.2 W. 75% of the patients had a previous MI and 59.3% underwent bypass surgery. During follow-up the previous job with heavy exertion was performed over a cumulated time of 74 years. The aim of the study was to compare the observed and the expected incidence of MI and cardiac death with and without job performance. The expected ("basal") risk for MI and cardiac death without heavy physical exertion was determined from pooled study results and assumed to be 5.2% per year. The combined risk due to performing an occupation with strenuous exertion can be calculated from time periods with and without working hours and amounts to 11.9%. There could be expected 0.119 . 74=8.8 cardiac events related to the job. In contrast, 5 MIs (4 NSTEMI, 1 STEMI) were observed (6.8%). The relative risk for an expected event compared to the basal risk without heavy exertion was 2.3 (95% CI: 0.7-7.4). The relative risk for the observed cardiac events amounts to 1.3 (95% CI: 0.4-4.8). The lower observed risk is probably due to the high grade of physical fitness in this patient group. In spite of several limitations, our study showed no convincing evidence for increasing the cardiac risk of patients with CAD performing occupations with heavy physical exertion. Because of the importance of this prognostic finding, a representative and prospective study is strongly required.
冠心病（CAD）患者与工作相关的重返工作岗位是心脏康复的核心部分。然而，特定的职业需求，如体力消耗大的工作（>6代谢当量）可能会增加心血管风险，因为剧烈运动后急性心肌梗死（MI）和心源性死亡的相对风险会暂时升高（“危险期”）。因此，2001年，任何确诊为CAD且在发生索引事件（MI/ACS、任何介入或外科血运重建措施）之前从事体力消耗大的工作的男性患者，在平均20个月后收到一份问卷。119名纳入患者中有108名（90.8%）提供了完整数据，年龄为51.8±7.8岁。射血分数为61.5±13.1%，出院时的功能能力平均为130.1±31.2瓦。75%的患者曾发生过MI，59.3%接受过搭桥手术。在随访期间，之前体力消耗大的工作累计进行了74年。该研究的目的是比较有和没有工作的情况下MI和心源性死亡的观察发病率和预期发病率。无体力消耗时MI和心源性死亡的预期（“基础”）风险根据汇总研究结果确定，假定为每年5.2%。从事剧烈体力消耗职业的综合风险可根据有工作时间和无工作时间的时间段计算得出，为11.9%。预计与工作相关的心脏事件为0.119×74 = 8.8起。相比之下，观察到5例MI（4例非ST段抬高型心肌梗死，1例ST段抬高型心肌梗死）（6.8%）。与无剧烈体力消耗的基础风险相比，预期事件的相对风险为2.3（95%CI：0.7 - 7.4）。观察到的心脏事件的相对风险为1.3（95%CI：0.4 - 4.8）。观察到的风险较低可能是由于该患者群体的身体素质较高。尽管存在一些局限性，但我们的研究没有显示出令人信服的确凿证据表明从事体力消耗大职业的CAD患者心脏风险增加。鉴于这一预后发现的重要性，强烈需要进行一项具有代表性的前瞻性研究。
