Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany.
Curr Med Res Opin. 2010 Apr;26(4):803-11. doi: 10.1185/03007991003604216.
The aim was to evaluate the effect of short-term cardiac rehabilitation (CR) on clinical events during a 1-year follow-up after acute myocardial infarction.
From the observational, prospective Acute COronary Syndromes (ACOS) registry, 4547 consecutive patients after ST-elevation (STEMI: n = 2432) or non-ST-elevation myocardial infarction (NSTEMI: n = 2115), recruited between June 2000 and December 2002, were characterised and evaluated for clinical outcomes during a 1-year follow-up. From the STEMI group 67.8% and from the NSTEMI group 52.3% participated in cardiac rehabilitation (CR+).
Age > 70 years and previous myocardial infarction were independent predictors not to attend CR in STEMI and NSTEMI patients, whereas early revascularisation (<48 hours after hospital admission) was associated with increased likelihood to undergo CR. Multivariable analysis adjusting for propensity score shows that CR+ was independently associated with a significant reduction of all-cause mortality (STEMI: OR 0.41, 95% CI 0.28-0.60; NSTEMI: OR 0.53, 95% CI 0.38-0.76) and major adverse cardiac and cerebrovascular events (MACCE; STEMI: OR 0.66, 95% CI 0.49-0.89; NSTEMI: OR 0.73, 95% CI 0.55-0.98) during a 1-year follow-up.
The study shows an independent and strong association of CR+ with markedly reduced total mortality and MACCE during a 1-year follow-up after STEMI or NSTEMI. The limitation of the study is that it is not a prospective randomised trial. Furthermore, unequal distribution of risk factors relevant for long-term prognosis had to be corrected by multivariable analysis adjusting for propensity score.
评估短期心脏康复（CR）对急性心肌梗死（AMI）后 1 年随访期间临床事件的影响。
从观察性、前瞻性急性冠状动脉综合征（ACOS）登记处，入选 2000 年 6 月至 2002 年 12 月期间连续招募的 4547 例 ST 段抬高型心肌梗死（STEMI：n=2432）或非 ST 段抬高型心肌梗死（NSTEMI：n=2115）患者，对其进行特征描述，并评估 1 年随访期间的临床结局。STEMI 组中有 67.8%，NSTEMI 组中有 52.3%的患者接受了心脏康复（CR+）。
年龄>70 岁和既往心肌梗死是 STEMI 和 NSTEMI 患者不参加 CR 的独立预测因素，而早期血运重建（入院后<48 小时）与接受 CR 的可能性增加相关。多变量分析校正倾向评分显示，CR+与全因死亡率（STEMI：OR 0.41，95%CI 0.28-0.60；NSTEMI：OR 0.53，95%CI 0.38-0.76）和主要不良心脑血管事件（MACCE；STEMI：OR 0.66，95%CI 0.49-0.89；NSTEMI：OR 0.73，95%CI 0.55-0.98）的显著降低独立相关。
该研究显示，CR+与 STEMI 或 NSTEMI 后 1 年随访期间总死亡率和 MACCE 的显著降低具有独立且强烈的关联。该研究的局限性在于它不是一项前瞻性随机试验。此外，必须通过多变量分析校正倾向评分来校正与长期预后相关的风险因素的不均衡分布。
