常规运动训练可降低急性心肌梗死后经皮冠状动脉介入治疗患者的冠状动脉再狭窄率。

Regular exercise training reduces coronary restenosis after percutaneous coronary intervention in patients with acute myocardial infarction.

机构信息

Department of Cardiology, Severance Hospital, Yonsei University, Seoul, Republic of Korea.

出版信息

Int J Cardiol. 2013 Sep 10;167(6):2617-22. doi: 10.1016/j.ijcard.2012.06.122. Epub 2012 Jul 12.

DOI:10.1016/j.ijcard.2012.06.122

PMID:22795710

Abstract

BACKGROUND

It is well known that cardiac rehabilitation (CR) including regular exercise training (ET) is cardioprotective with respect to clinical events in patients with acute myocardial infarction (AMI). However, it is not known whether the regular ET may affect coronary restenosis after percutaneous coronary intervention (PCI) with stenting in AMI. The aim of this study was to evaluate the effect of regular ET on a stented coronary segment and its association with inflammatory markers in AMI.

METHODS

Consecutively 74 AMI patients who underwent PCI with implantation of a drug-eluting stent and 9 month follow-up angiography were included. Thirty seven patients who received CR with ET were assigned to the ET group. Another 37 patients who did not participate in ET, of similar age to those of participants, were assigned to the control group. At 9 months, angiographic restenosis measured as in-segment late luminal loss of the stented coronary artery was analyzed via quantitative coronary angiography using CAAS 5.9.

RESULTS

There were no significant differences in baseline characteristics including age, sex, body mass index, smoking, DM, hypertension, lipid profile, use of statin, and complete blood cell between two groups. On 9 month follow-up angiography, late luminal loss per stent was significantly smaller in the ET group compared to the control group (0.14 ± 0.57 vs. 0.54 ± 0.88 mm, p=0.02). Maximal oxygen consumption (VO2max) significantly improved in the ET group after 9months (27.9 ± 6.4 vs. 30.8 ± 5.2 mL/kg/min, p<0.001). Increment in high density lipoprotein-cholesterol (HDL-C) was significantly larger in the ET group at 9 months (0.15 ± 0.12 vs. 0.04 ± 0.24 mg/dL, p=0.03).

CONCLUSION

Regular ET contributes to a significant reduction in late luminal loss in the stented coronary segment in AMI patients. This effect was associated with increased exercise capacity and increased HDL-C.

摘要

背景

众所周知，心脏康复（CR）包括定期运动训练（ET）对急性心肌梗死（AMI）患者的临床事件具有心脏保护作用。然而，目前尚不清楚定期 ET 是否会影响 AMI 患者经皮冠状动脉介入治疗（PCI）后支架内再狭窄。本研究旨在评估定期 ET 对支架置入冠状动脉节段的影响及其与 AMI 中炎症标志物的关系。

方法

连续纳入 74 例接受 PCI 置入药物洗脱支架并随访 9 个月的 AMI 患者。37 例接受 CR 和 ET 的患者被分配到 ET 组。另外 37 例年龄与患者相似但未接受 ET 的患者被分配到对照组。9 个月时，通过 CAAS 5.9 定量冠状动脉造影分析支架置入冠状动脉节段的晚期管腔丢失来评估血管造影再狭窄。

结果

两组患者的基线特征（包括年龄、性别、体重指数、吸烟、DM、高血压、血脂谱、他汀类药物的使用以及全血细胞计数）无显著差异。在 9 个月的随访血管造影中，ET 组的晚期管腔丢失明显小于对照组（0.14±0.57 与 0.54±0.88mm，p=0.02）。ET 组 9 个月后最大摄氧量（VO2max）显著提高（27.9±6.4 与 30.8±5.2mL/kg/min，p<0.001）。ET 组 9 个月时高密度脂蛋白胆固醇（HDL-C）的增加量明显大于对照组（0.15±0.12 与 0.04±0.24mg/dL，p=0.03）。