Pouche Marion, Ruidavets Jean-Bernard, Ferrières Jean, Iliou Marie-Christine, Douard Hervé, Lorgis Luc, Carrié Didier, Brunel Philippe, Simon Tabassome, Bataille Vincent, Danchin Nicolas
Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France.
Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France.
Arch Cardiovasc Dis. 2016 Mar;109(3):178-87. doi: 10.1016/j.acvd.2015.09.009. Epub 2015 Dec 23.
Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality.
To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI).
Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model.
At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs.≥60years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40).
After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.
临床研究表明心脏康复（CR）对死亡率有有益影响。
研究出院时CR处方对急性心肌梗死（AMI）患者5年死亡率的影响。
参与者来自2005年法国FAST-MI医院登记处，为2894名出院幸存者，根据AMI类型分为：ST段抬高型心肌梗死（STEMI；n = 1523）和非STEMI（NSTEMI；n = 1371）。使用Cox比例风险模型分析CR处方对死亡率的影响。
出院时，22.1%的患者有CR处方。被转诊至CR的患者更年轻（62.4岁对67.5岁），男性比例更高，且与未被转诊的患者相比，更多表现为STEMI（67.8%对48.3%）。被转诊至CR的患者中有94例（14.7%）死亡，未被转诊的患者中有585例（25.9%）死亡（P<0.001）。多变量调整后，CR与死亡率之间的关联仍然显著（风险比[HR] 0.76，95%置信区间[CI] 0.60 - 0.96）。按性别、年龄（<60岁对≥60岁）和AMI类型分层分析显示，男性（HR 0.64，95% CI 0.48 - 0.87）的反向关联比女性（HR 0.95，95% CI 0.64 - 1.39）更强，年轻患者（HR 0.34，95% CI 0.15 - 0.77）比老年患者（HR 0.84，95% CI 0.65 - 1.07）更强，NSTEMI患者（HR 0.63，95% CI 0.46 - 0.88）比STEMI患者（HR 0.99，95% CI 0.69 - 1.40）更强。
AMI住院后，转诊至CR仍然是患者生存改善的重要预测因素；一些亚组似乎获益更大。
