Department of Cardiology, Medical University of Lodz, Lodz, Poland -
Eur J Phys Rehabil Med. 2013 Dec;49(6):785-91. Epub 2013 Apr 5.
There are no reliable data concerning the safety and benefits of physical rehabilitation in patients with a two-vessel disease before the second stage of angioplasty. The aim of this study was to evaluate the efficiency of early cardiac rehabilitation in patients with acute coronary syndromes and with angiographically significant residual coronary artery stenosis after a successful percutaneous coronary intervention (PCI) into the culprit lesion.
Retrospective analysis of the results of coronary angiograms and exercise tests of patients who underwent stationary rehabilitation after their first ACS and first PCI.
Cardiac Rehabilitation Department.
One hundred ninety patients divided into 2 groups according to the completeness of myocardial revascularization; 49 with significant (≥70%) coronary artery stenosis in a non-culprit vessel, the mean diameter reduction 80±9%; and 141 without any residual stenosis. The prevalence of classical risk factors was comparable in both groups. Rehabilitation was conducted as a stationary 3-week program.
Comparison of the initial and final exercise test workload in both groups, as well as the frequency of adverse effects during the program.
Physical training in patients with incomplete revascularization (IR) was safe and well tolerated. Significant increase of workload capacity after the rehabilitation program was observed in both groups: in the IR group from 7.3±3.0 to 8.8±2.9 MET (P<0.0001) and in the complete revascularization (CR) group - from 7.6±2.8 to 9.2±2.9 MET (P<0.0001). No significant difference was observed in initial workload capacities (P=0.9813) nor in final workload capacities (P=0.8571) between the two groups. Two patients in the group with residual lesion (4%) and one in the group without residual lesion (0.7%) required urgent PCI during the rehabilitation program, P=0.1637.
Early postinfarction physical training is safe and efficient for patients after complete revascularization and for those with untreated non-culprit coronary artery stenosis. Gradual increase in physical training intensity under cardiologist supervision is essential in identifying those rare patients for whom the second stage of angioplasty should not be delayed.
Our study shows that patients with incomplete revascularization may be qualified for cardiac rehabilitation programs.
在经皮冠状动脉介入治疗（PCI）成功治疗罪犯病变后，对于存在两血管病变且存在有意义的残余冠状动脉狭窄的急性冠状动脉综合征患者，第二阶段血管成形术之前的物理康复的安全性和益处尚无可靠数据。本研究旨在评估急性冠状动脉综合征患者早期心脏康复的效率，这些患者的罪犯病变已经成功接受 PCI。
对首次急性冠状动脉综合征和首次 PCI 后接受固定康复的患者的冠状动脉造影和运动试验结果进行回顾性分析。
心脏康复科。
190 例患者根据心肌血运重建的完整性分为 2 组；49 例非罪犯血管存在显著（≥70%）冠状动脉狭窄，平均直径狭窄 80±9%；141 例无任何残余狭窄。两组的经典危险因素患病率相当。康复作为一个为期 3 周的固定方案进行。
比较两组患者初始和最终运动试验工作负荷，以及方案期间不良反应的发生频率。
不完全血运重建（IR）患者的体能训练是安全且耐受良好的。在康复方案后，两组的工作负荷能力均显著增加：IR 组从 7.3±3.0 增加到 8.8±2.9 MET（P<0.0001），完全血运重建（CR）组从 7.6±2.8 增加到 9.2±2.9 MET（P<0.0001）。两组患者的初始工作负荷能力无显著差异（P=0.9813），最终工作负荷能力也无显著差异（P=0.8571）。在康复方案期间，有 2 例（4%）残余病变患者和 1 例（0.7%）无残余病变患者需要紧急 PCI，P=0.1637。
对于完全血运重建患者和未治疗的非罪犯冠状动脉狭窄患者，早期心肌梗死后的体能训练是安全且有效的。在心脏病专家的监督下，逐渐增加体能训练强度对于确定哪些罕见患者不应延迟第二阶段血管成形术至关重要。
我们的研究表明，不完全血运重建的患者可能有资格参加心脏康复计划。
