Coll-Fernández Roser, Coll Ramon, Muñoz-Torrero Juan F Sánchez, Aguilar Eduardo, Ramón Álvarez Lorenzo, Sahuquillo Joan Carles, Yeste Montserrat, Jiménez Pedro Enrique, Mujal Abel, Monreal Manuel
Department of Physical Medicine and Rehabilitation, Hospital Universitari Parc Taulí Sabadell, Spain Universitat Autònoma de Barcelona, Spain
Department of Physical Medicine and Rehabilitation, Hospital Universitari Germans Trias i Pujol, Spain.
Eur J Prev Cardiol. 2016 Feb;23(3):245-52. doi: 10.1177/2047487315578443. Epub 2015 Mar 23.
The influence of supervised versus non-supervised exercise training on outcome in patients with a recent myocardial infarction (MI) is controversial.
Longitudinal observational study.
FRENA is an ongoing registry of stable outpatients with symptomatic coronary, cerebrovascular or peripheral artery disease. We compared the rate of subsequent ischaemic events (MI, ischaemic stroke or lower limb amputation) and the mortality rate in patients with recent MI, according to the use of supervised versus non-supervised exercise training. The influence of physical activity on outcomes was estimated by using propensity score method in multivariate analysis.
As of February 2014, 1124 outpatients with recent MI were recruited, of whom 593 (53%) participated in a supervised exercise training programme. Over a mean follow-up of 15 months, 25 patients (3.3%) developed 26 subsequent ischaemic events - 24 MI, one stroke, one lower-limb amputation - and 12 (1.6%) died. The mortality rate (0.15 vs. 2.89 deaths per 100 patient-years; rate ratio = 0.05; 95% confidence interval, 0.01-0.39) was significantly lower in supervised exercise than in non-supervised exercise patients. On propensity score analysis, the rate of the composite outcome was significantly lower in supervised exercise patients (1.80 vs. 6.51 events per 100 patient-years; rate ratio = 0.28; 95% confidence interval, 0.12-0.64).
The use of supervised exercise training in patients with recent MI was associated with a significant decrease in the composite outcome of subsequent ischaemic events and death.
有监督的运动训练与无监督的运动训练对近期心肌梗死（MI）患者预后的影响存在争议。
纵向观察性研究。
FRENA是一个正在进行的登记研究，纳入有症状的冠状动脉、脑血管或外周动脉疾病的稳定门诊患者。我们比较了近期MI患者中，接受有监督运动训练与无监督运动训练者后续缺血性事件（MI、缺血性卒中或下肢截肢）的发生率及死亡率。在多变量分析中，采用倾向评分法评估体力活动对预后的影响。
截至2014年2月，招募了1124例近期MI门诊患者，其中593例（53%）参加了有监督的运动训练项目。平均随访15个月，25例患者（3.3%）发生了26次后续缺血性事件——24次MI、1次卒中、1次下肢截肢——12例（1.6%）死亡。有监督运动训练患者的死亡率（每100患者年0.15例死亡 vs. 2.89例死亡；率比 = 0.05；95%置信区间，0.01 - 0.39）显著低于无监督运动训练患者。倾向评分分析显示，有监督运动训练患者的复合结局发生率显著更低（每100患者年1.80次事件 vs. 6.51次事件；率比 = 0.28；95%置信区间，0.12 - 0.64）。
近期MI患者使用有监督的运动训练与后续缺血性事件和死亡的复合结局显著降低相关。
